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Research paper
Cognitive and psychosocial function in retired professional hockey players
  1. Carrie Esopenko1,2,
  2. Tiffany W Chow3,
  3. Maria Carmela Tartaglia4,5,
  4. Agnes Bacopulos1,
  5. Priya Kumar1,6,
  6. Malcolm A Binns1,7,
  7. James L Kennedy8,9,
  8. Daniel J Müller8,9,
  9. Brian Levine1,7
  1. 1Baycrest Health Sciences, Rotman Research Institute, Toronto, Canada
  2. 2Department of Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
  3. 3University of Southern California, Los Angeles, California, USA
  4. 4Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Canada
  5. 5Division of Neurology, Krembil Neuroscience Centre, Toronto, Canada
  6. 6Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
  7. 7University of Toronto, Toronto, Canada
  8. 8Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  9. 9Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr. Brian Levine, Rotman Research Institute, Baycrest Health Sciences, 3560 Bathurst Street, Toronto, Ontario, Canada M6A 2E1; blevine{at} Dr. Carrie Esopenko, Department of Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, 65 Bergen Street, Newark, NJ, USA 07107; carrie.esopenko{at}


Background and Objective The relationship between repeated concussions and neurodegenerative disease has received significant attention, particularly research in postmortem samples. Our objective was to characterise retired professional ice hockey players’ cognitive and psychosocial functioning in relation to concussion exposure and apolipoprotein ε4 status.

Methods Alumni athletes (N=33, aged 34–71 years) and an age-matched sample of comparison participants (N=18) were administered measures of cognitive function and questionnaires concerning psychosocial and psychiatric functioning.

Results No significant group differences were found on neuropsychological measures of speeded attention, verbal memory or visuospatial functions, nor were significant differences observed on computerised measures of response speed, inhibitory control and visuospatial problem solving. Reliable group differences in cognitive performance were observed on tests of executive and intellectual function; performance on these measures was associated with concussion exposure. Group differences were observed for cognitive, affective and behavioural impairment on psychosocial questionnaires and psychiatric diagnoses. There was no evidence of differential effects associated with age in the alumni athletes. Possession of an apolipoprotein ε4 allele was associated with increased endorsement of psychiatric complaints, but not with objective cognitive performance.

Conclusions We found only subtle objective cognitive impairment in alumni athletes in the context of high subjective complaints and psychiatric impairment. Apolipoprotein ε4 status related to psychiatric, but not cognitive status. These findings provide benchmarks for the degree of cognitive and behavioural impairment in retired professional athletes and a point of comparison for future neuroimaging and longitudinal studies.

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  • Contributors CE and BL were responsible for study design, data collection, data analysis and manuscript preparation; TWC and MCT were responsible for neurological data collection and manuscript preparation; AB and PK were responsible for data collection and data analysis; MAB was responsible for data analysis; JLK and DJM were responsible for genetic data analyses.

  • Funding Canadian Institutes of Health Research Catalyst (CIHR; Grant # CBT 127060) Ontario Neurotrauma Foundation (Grant # 2012-ABI-CAT3-973) CIHR Operating Grant (Grant # MOP133728) Alzheimer’s Society of Canada’s Research Program Post Doctoral Fellowship awarded to CE.

  • Competing interests BL provides expert consultation on medicolegal cases involving brain injury and neurodegenerative disease, and he receives royalties for sales and training for the Goal Management Training® intervention for executive function impairments. JLK has received speaker fees from pharmaceutical companies.

  • Ethics approval Baycrest Health Sciences IRB.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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