Football and dementia: examining the evidence

A possible link between dementia and head injuries sustained playing football is the subject of a new BBC documentary. Our researchers examine the evidence.

The question of whether sustaining head injuries during football can increase the risk of dementia has been in the news a lot recently. Now, it's also the subject of a BBC documentary presented by former England striker Alan Shearer.

However, there are still many questions that need to be answered on this issue.

football-and-dementia-alan-shearer 'Alan Shearer: Football, dementia and me' premieres at 10.30pm on Sunday 12 November

To address some of these questions, Alzheimer’s Society hosted a roundtable discussion with researchers who have expertise in the areas of brain injury and how dementia affects the brain.

The purpose of the discussion was to understand more about the role of head injury in dementia risk, particularly focusing on injuries experienced by both professional and recreational football players. This expert input will support Alzheimer’s Society in communicating this issue to the public and media.

We have published a more complete report that also sets out recommendations for the types of research needed in this area.

What do we know?

Having a severe head injury of any cause, especially one that results in a long period of unconsciousness, is an established risk factor for dementia.

For example, a recent study of nearly 200,000 US war veterans found that there was a 60% increase in the risk for developing dementia in those people who had a history of head injury. However there are very few similar-style studies that compare professional athletes who have sustained head injuries to those who haven’t, and the existing studies are quite small.

The link between milder head injuries and risk of dementia is much less clear. A ‘milder’ head injury includes those that don’t result in loss of consciousness or just are impacts that occur during sport such as heading the ball in football.

The risk of dementia that a person has is also likely to be related to how severe the head injury was and the number of times a person is injured. This makes the need to gather evidence particularly important for professional football players who are more likely to have multiple head injuries, both minor and severe, throughout their careers.

What’s going on in the brain?

Studies that have examined the brains of sportspeople after they have died have identified that a condition called Chronic Traumatic Encephalopathy (CTE) could be linked to high-collision sports, most notably American Football. CTE shares some of the underlying features of some forms of dementia, for instance the build-up of tangles of the tau protein.

A few small studies have also shown the presence of CTE in other sports professionals such as footballers, and there have also been high profile single autopsy studies reported in the media. Few of these studies compare the brains of footballers who had CTE with those who didn’t, and another issue is a ‘selection bias’, as former footballers who showed symptoms of dementia are more likely to donate their brain.

A complication with much of the research is that the brains of many people examined as part of these studies have signs of more than one form of dementia in their brain. This includes CTE but also Alzheimer’s disease, dementia with Lewy bodies and frontotemporal dementia, among others. This means it is hard to know whether the signs of dementia that a person was experiencing were down to CTE or another form of dementia.

It is also important to note that not everyone who sustains a head injury will go on to develop dementia, or show signs of CTE if they have an autopsy.

While research into head injuries and football risk is quite new, improvements in this area will help researchers to make progress in this area. This includes a greater awareness of CTE and how to find signs of it in the brain, and advances in brain scanning technology that allow for people to be monitored during their lifetime.

Bringing the evidence together

Based on current evidence, the risk arising from contact sports (such as football) in the development of dementia remains uncertain.

If such a link does exist, the contribution of concussion and milder forms of head injury to overall risk is likely to be small. However, even this small risk may be significant from a public health perspective because of the large number of people who play sports such as football, and because the risk is potentially modifiable.

In concluding, it was acknowledged by the experts at the roundtable that there were challenges to be faced when developing definitive research evidence in this area. The experts also highlighted the fact that the lack of available evidence does not mean a link does not exist.

Traumatic brain injury, even if mild, can have a number of serious consequences, regardless of whether it is sustained either during sport or in other contexts. Consequently, there is a rational argument to reduce the risk of sustaining a head injury as far as reasonably possible.

football-and-dementia-alan-shearer-lab Footballer Alan Shearer explores the impact of dementia on the brain for a new BBC documentary

What is Alzheimer’s Society calling for?

It is important that people should be able to enjoy sport as safely as possible. Therefore Alzheimer’s Society would like to see more research that aims to answer some of the lingering questions about head injuries in sport and dementia risk.

We would like to see greater monitoring and recording of head injury sustained during sports, particularly injuries that result in concussion or loss of consciousness. This is particularly relevant to professional sporting bodies and associations who have a duty of care to their players in the short and long-term.

We would also like to see the research community incorporate the issue of head injury into their research, by including recording of head injuries during long term health and lifestyle studies.

Should I be worried about head injuries in football and dementia?

We know that exercise appears to be one of the best things to do to reduce your risk of dementia. We encourage everyone to enjoy sport as safely as possible.

While it is not recommended you should wear a helmet to protect you from concussion, we do encourage vigilance when it comes to noticing and recording head injuries, particularly if they result in concussion or loss of consciousness. If you have any worries about a head injury sustained during sport or elsewhere, please do speak to your GP.

How to reduce your risk of dementia

Although getting older is the biggest risk factor for dementia, evidence shows there are things you can do to help reduce your own risk. 

Reduce your risk

11 comments

Add your own

Personally I think there is undoubtably a link. My father an ex professional footballer now has Alzheimer's as do a lot of players from the same era (60's & 70's). There defiantly needs to be more research carried out. Unfortunately it's too late for my fathers generation but if this can be prevented for todays & future generations then research is imperative.

A recent editorial from us on the subject.

http://bjsm.bmj.com/content/early/2017/07/20/bjsports-2017-097627

I have played for 30 years with many heading activites from a young age and some other head traumas.
Is there a way to join the research pool if it helps towards the results

Hi there, thanks for your comment. The Professional Footballers’ Association (PFA) are funding research in this area and we are waiting for them to detail how they are going to recruit people to their study. We will pass on this information when we know more so keep an eye out on our social media channels.

In the meantime, you might like to consider registering for Join Dementia Research. This services matches people to dementia research studies. There is no obligation to join a study if you are matched to it but you can keep an eye out to see if you are matched to any studies that mention or are specifically looking at head injury or the effects of contact sport. You can call our helpline on 0300 222 11 22 if you’d like more information on Join Dementia Research.

- Alzheimer’s Society Research team.

I like hitting with head sir

Hi my name is Alan Dugdale my age is65,I was a pro footballer back in the 70s.Iam a bit concerned about this dementia,as I was a centre half heading the ball thousands of times,and the back of other players heads,as well as being kicked in the face.but enjoyed every minute I played.how can I help players and the kids who are now playing,and can anyone help me to see if I am going to be inflicted .thank you for listening. Yours sincerely Alan Dugdale.

Hi Alan – thank you for your comments. We are currently working with various relevant organisations to understand how we can help people in situations like yours to take part in research about sports-related head injury and dementia risk. We will keep everyone updated on our progress, so please do keep an eye out on our social media channels and website.

In the meantime, if you are worried about your memory, please do go and speak to your GP

Is the drake study that is investigating the link between heading footballs and dementia a seperate study from the collaborative effort study between the FA and PFA overseen by Dr Willlie Stewart? I think it’s the HEADER study?

Hi Mark,

The FIELD Study, being conducted by Dr Willie Stewart and funded by the FA/PFA is actually being overseen by The Drake Foundation. The study was announced in November 2017 and will assess Scottish medical records for any links between a footballing career and later-life dementia diagnoses. You can find more details at https://gbirg.inp.gla.ac.uk/the-field-study/.

The Drake Foundation also hopes to launch its own separate study on the topic very soon. The more research we have the better.

My Husband Died with dementia ,He was a football player and loved the
Game ,He also Loved his job working as a design draftsmanship ,on Large buildings ,
He died in his fifties , I miss him so much he was an amazing man,
My Children missed him and his family ,

Thank you I have happy memories,

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