Focus: Dementia and Football

Brain Scan

To mark Dementia Action Week 2019, we take a look at the studies underway to help increase understanding about the potential risk of dementia for footballers. 

Concussion has long been a strongly debated topic in the world of contact sports. There has been wide discussions about the connection between contact sport, concussion and the development of neurocognitive problems in later life, with a particular media focus on Chronic Traumatic Encephalopathy (CTE) - a form of dementia. 

Currently, there is no conclusive evidence confirming a link between contact sports and the development of degenerative neurocognitive disease. For footballers and their families who have experienced the devastating effects of dementia, this has been incredibly frustrating, and for the last twenty years, the issue has been high on the agenda at the PFA. 

In 2001, the PFA began funding a research study into concussion and dementia, which was abruptly cut short by the research team due to logistical issues with the participants and control groups. When the results were finally published in 2016, acknowledgement of the PFA’s support was missing, leading some to suggest the organisation wasn’t taking dementia seriously. In truth, research into football and dementia is still relatively new, but the PFA have been funding relevant studies to try and find answers for members and their families. The union has also been supporting those dealing with dementia and committed to multiple studies to determine if there is a link between heading a football and developing neurological problems later in life.

What exactly is CTE? CTE stands for Chronic Traumatic Encephalopathy and is a delayed degenerative brain disease, with symptoms similar to Alzheimer’s or Parkinson’s Disease. CTE has been found in some athletes, those who have served in the forces, and others who have experienced repeated trauma to the head. This has caused people to suggest that concussions, and sub-concussions - where you sustain a head injury but do not pass out, lead to CTE or other types of dementia - but at present, there isn’t enough data to support this claim. Not everyone who sustains multiple concussions or sub-concussions has gone on to develop such conditions, and it isn’t clear if there are also genetic factors at play. So far, research shows that 10% of the general public develop CTE, including those who haven’t suffered repeated mild brain injuries, so there are still many questions to answer.  At the moment, one of the biggest challenges in understanding CTE is that it can only be diagnosed post-mortem. Equally, CTE is only one type of dementia and is not present in all dementia cases. Researchers are working hard to understand the causes of the condition, and how to diagnose it when a patient is still alive.

The PFA is currently involved in three separate studies that focus on football and the possible development of dementia. In addition to financial support, PFA staff have committed to becoming subjects of one of the studies carried out by the International Concussion and Head Injury Research Foundation (ICHIRF). Deputy Chief Executive, John Bramhall, is one of a group of senior staff at the PFA who have agreed to enter the ICHIRF study and eventually donate their brains, to see if any physical evidence of dementia is present. This has meant a rigorous round of cognitive and physical testing, with regular updates and monitoring to detect changes. The study, led by former British Horseracing Chief Medical Adviser, Dr Michael Turner, aims to identify if contact sport athletes should be concerned about developing dementia.

The study initially focused on retired jockeys but expanded to include other sportsmen and women who had suffered concussions, including footballers, skiers and other equestrian athletes. The research compares the participants to a control group matched by age, gender and background without any history of repetitive brain injuries, to detect any differences.

John has been open about what he believes is ‘unfair criticism’ of the PFA when it comes to dementia. He says, “We’d like to have more clarity in this area, so this is an opportunity to contribute to that. We’re all former players in here. I’ve played over 500 games through the 70s into the 90s. We want to know for our own sakes and everybody around us. We want to know for our teammates and people that we’ve known for years. Because it’s doused in uncertainty, we need studies to provide empirical evidence confirming a link between football and dementia – or conclusively prove otherwise.”

When it came to joining the study, John found making the decision fairly easy, saying, “I’m keen to see what’s happening in there [with the study’s scans]. You hope that the scans will be positive in terms of your personal health, but if it’s a negative – it is what it is. I guess to take part, you have to deal with that possibility and move on, but personally, I think it’s a good step. The donation of the brain sounds absolutely horrendous, but when I get to that point, I won’t know anything about it.  Ultimately, if it helps and it can add information to the area, then it’s fine with me.”

The PFA has also contributed significant funding to an independent study led by Dr William Stewart of Glasgow University, titled ‘Football’s Influence on Lifelong Health and Dementia Risk’ (FIELD). The three-year research project was commissioned in conjunction with the FA and began in January 2018, with a halfway report already filed. When finished, the study will have compared data from around 15,000 former professional footballers with information about the general population, and Dr Stewart is also asking people to donate their brains for research.

In addition, the PFA is involved in a study with the DRAKE Foundation, helping them to source 300 suitable participants for an examination of the link between heading the ball, concussions and long-term cognitive function.  As the foundation is covering the costs of this study, the PFA has allocated more funding to another research project into the area, which will be announced in due course.