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Concussion, dementia and CTE: are we getting it very wrong?
  1. Alan Carson
  1. Reader in Neuropsychiatry, Centre for Clinical Brain Studies, University of Edinburgh, Edinburgh, Scotland
  1. Correspondence to Dr Alan Carson, Robert Fergusson Unit, Royal Edinburgh Hospital, Tipperlin road, Edinburgh EH10 5HF, Scotland; a.carson{at}

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A little less conversation, a little more science please

There has been a large media interest over the recent years in the long-term health effects of concussive injuries sustained by sportsman, culminating in a Hollywood movie ‘Concussion’ starring Will Smith. Hardly a week goes by without further studies being announced in the media and creating considerable interest in social media. The message is that concussion is a dangerous condition that causes a complex neuropsychiatric disorder, chronic traumatic encephalopathy (CTE), with a neuropsychiatric phenotype of mood change, irritability and suicidal behaviour which develops over time into a neurodegenerative disorder and death.1 Increasing alarm has followed, and it has been suggested that this is not just a disorder of elite sportsman but a problem for youth sport and that even heading a football (soccer) may cause dementia,2 a terrifying prospect for those parents trying to decide whether to allow their children to participate in sports.

This journal features, two well-conducted studies examining the outcome of elite rugby and ice hockey players. Both studies offer reassuring messages. Macmillan et al3 study of cognitive outcomes in retired Scottish International rugby players, mean age 54 and a mean of 20 years after retirement, found no significant effects of concussion. The ice hockey cohort4 does not have the same number of years of follow-up but at least in the short term is similarly reassuring, although the authors are appropriately cautious that the long-term follow-up data must be awaited. Both studies used opportunistic cohorts and as such selective sampling, non-participation and choice of controls will be valid criticisms.

But the more important question might be asked, ‘Why are these studies seemingly at such odds with the prevailing wind?’ Part of the problem may be that much of the debate has been played out in mainstream media rather than scientific journals. To tackle this more …

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  • Competing interests I have given independent testimony in Court 50% plaintiff, 50% defender on a range of neuropsychiatric topics including acquired brain injury. I run a free to access, not for profit website which is a self help guide for patients after mild brain injury.

  • Provenance and peer review Commissioned; internally peer reviewed.

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