July 9, 2020Open Access
Modifiable Risk Factors for Poor Cognitive Function in Former American-Style Football Players: Findings from the Harvard Football Players Health Study
Key Result
High pain interference in daily life was strongly associated with moderate or severe impairment in cognition-related quality of life among former NFL players (RR 2.70).
Study Design
Type
Cross-Sectional (n=3,803)
Structured PICO
Are modifiable risk factors associated with poor cognition-related quality of life in former NFL players?
P
Population
3,803 former National Football League (NFL) players
I
Intervention
Presence of self-reported modifiable risk factors (e.g., cardiovascular health, sleep, pain, depression, anxiety, smoking, physical impairment, and physical activity)
C
Comparator
Absence or lower levels of these risk factors (e.g., comparing 'healthy concussed' to 'unhealthy concussed')
O
Outcome
Cognition-related quality of life, measured by the Quality of Life in Neurological Disorders, Applied Cognition-General Concerns (Neuro-QOL)patient reported
Modifiable risk factors such as chronic pain, mood problems, sleep problems, obesity, and lack of exercise are strongly associated with cognition-related impairment in former NFL players.
Main Result
Effect estimate: RR 2.70 (95% CI 2.52-2.88)
p-value: p=<0.0001
Limitations
- Cross-sectional design limits the ability to determine causality or the sequencing of cognitive risk factors.
- Retrospective assessment of concussion symptoms during playing years may be subject to recall bias.
- Reliance on self-reported data for medical conditions, weight, height, and symptoms.
Abstract
Recent attention to consequences of head trauma among former professional American-style football players has increased the likelihood that former players and their healthcare providers attribute neurocognitive effects to these exposures. In addition to head trauma, however, many potentially modifiable risk factors are associated with cognitive impairment. We examined the association of self-reported risk factors for cognitive impairment (e.g., cardiovascular health, sleep, pain, depression, anxiety, smoking, physical impairment, and physical activity) with cognition-related quality of life, measured by the Quality of Life in Neurological Disorders, Applied Cognition-General Concerns (Neuro-QOL) among 3803 former National Football League (NFL) players. We examined the prevalence of risk factors among men who had experienced a high number of concussion symptoms during playing years, comparing men with good current cognition-related QOL, the “healthy concussed,” to men with poor cognition-related QOL, the “unhealthy concussed.” Physical functioning, pain, depression, and anxiety were very strongly associated with poor cognitive-related QOL (risk ratio range, 2.21–2.70, p 10 percentage points). We identified cognitive risk factors, including chronic pain, mood problems, sleep problems, obesity, and lack of exercise, that were commonly present in former football players with cognition-related impairment. Better treatment for these factors may reduce cognitive problems in this population.
Cite This Study
Roberts et al. (Thu,) conducted a cross-sectional in Poor cognitive function in former American-style football players (n=3,803). High pain interference in daily life vs. Low pain interference was evaluated on Moderate or severe impairment in cognition-related quality of life (Neuro-QOL) (RR 2.70, 95% CI 2.52-2.88, p=<0.0001). High pain interference in daily life was strongly associated with moderate or severe impairment in cognition-related quality of life among former NFL players (RR 2.70).