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Cognitive neurology
Review
Concussion and long-term cognitive impairment among professional or elite sport-persons: a systematic review
  1. Valentina Gallo1,2,3,
  2. Kim Motley4,
  3. Simon P T Kemp3,5,
  4. Saba Mian3,
  5. Tara Patel1,6,
  6. Laura James1,
  7. Neil Pearce3,
  8. Damien McElvenny3,7,8
  1. 1 Institute of Population Health Sciences, Queen Mary, University of London, London, UK
  2. 2 School of Public Health, Imperial College London, London, UK
  3. 3 Department of Medical Statistics, London School of Hygiene and Tropical, London, UK
  4. 4 School of Medicine and Dentistry, Queen Mary University of London, London, UK
  5. 5 Rugby Football Union, Twickenham, London, UK
  6. 6 BSc in Biology, Imperial College London, London, UK
  7. 7 Institute for Occupational Medicine Edingburgh, Edingburgh, UK
  8. 8 University of Manchester, Manchester, UK
  1. Correspondence to Dr Valentina Gallo, CPCPH, Barts and The London School of Medicine and Dentistry, London E1 2AB, UK; v.gallo{at}qmul.ac.uk

Abstract

Introduction Understanding whether concussion in sport is associated with worsening cognitive function in later life will likely have immediate repercussion on sports concussion prevention and management policy and sporting rules and regulations. This systematic review aims to summarise the evidence on the association between concussion sustained by professional/elite athletes and long-term cognitive impairment.

Methods Embase, PubMed and Web of Science were used to search for eligible studies. Studies including professional/elite athletes from any sport were considered. Three comparison groups were considered: internal comparison (concussed vs non-concussed athletes within the same sample); between-sport comparison (contact sport athletes vs non-contact sports ones); external comparison (athletes vs samples of the general population or population norms).

Results 14 studies were included (rugby, American football, ice hockey players, boxers and marital art fighters). The general quality of the evidence was poor. The overall evidence, weighted for type of comparison and study quality, points towards an association between sustaining a sport-related concussion and poorer cognitive function later in life in rugby, American football and boxing, although it is unclear to what extent this is clinically relevant. Data on ice hockey and martial arts were too sparse to allow conclusions to be drawn.

Conclusion High-quality, appropriately designed and powered epidemiological studies are urgently needed to assess the association between sustaining a sport-related concussion and cognitive impairment later in life. Particular emphasis should be put on the clinical translational value of findings.

  • concussion
  • acquired brain injury
  • dementia
  • cognition
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/jnnp-2019-321170

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    Footnotes

    • Twitter @drvgallo, @drsimonkemp

    • VG and KM contributed equally.

    • Contributors Study concept and design: VG; Analysis and interpretation of data: VG, KM, SM, TP and DME; Drafting of the manuscript: VG and KM; Data collection: KM, SM and TP; Critical revision of the manuscript for important intellectual content: SK, LJ and NP.

    • Funding This study was partially funded by the Drake Foundation as part of the BRAIN study funded to London School of Hygiene and Tropical Medicine (EPMSZJ20-10) in collaboration with Queen Mary University of London and the Institute of Occupational Health.

    • Competing interests None declared.

    • Patient consent for publication Not required.

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