In edition 203 of BC Disease News (here), our feature article focused on ‘Degenerative Brain Disease In Football’. Specifically, we discussed the risk of heading footballs with the development of a form of dementia, called Chronic Traumatic Encephalopathy (CTE). Jeff Astle, deceased in 2002, aged 59, was the first known footballer to have been diagnosed with CTE, following an autopsy with Dr Willie Stewart.
The Coroner described Mr Astle’s death as an ‘industrial disease’ and this led to the creation of the Jeff Astle Foundation.
On 6 August 2018, Rod Taylor became the second British footballer to be diagnosed with dementia with Lewy bodies and Grade 3 CTE at post-mortem. The autopsy was carried out by Dr Stewart.[i] Subsequently, Dr Stewart has written to the Coroner’s office to suggest that his findings are added to the post-mortem report as the cause of death.
Mr Taylor, who previously played for Portsmouth, Gillingham and Bournemouth, died in April. His family has since joined the Jeff Astle Foundation, which are campaigning for football authorities and the Government to formally recognise certain dementias among players as an ‘industrial disease’, as well as encouraging the Professional Footballers’ Association to put more resources into ascertaining the ‘care crisis’ among former players and their families.
Elsewhere, the University of Washington School of Medicine has added to scientific evidence in support of a link between brain injury and dementia and Alzheimer’s disease.
In an article, published in the Lancet Psychiatry journal, in April 2018, researchers reported that those who sustain traumatic brain injuries have a higher risk of developing dementia and Alzheimer’s.[ii] This is thought to be one of the first studies to assess the effect of brain injury on long-term dementia risk using a sufficiently large sample size and follow-up time.[iii] [iv]
The researchers collected data from a cohort of 2,794,852 Danish inhabitants (the Danish Civil Registration System) at risk of dementia. All subjects turned 50 at some point during the follow-up period of 1999 to 2013.
Of this group, results showed that 132,093 individuals suffered at least 1 traumatic brain injury between 1977 and 2013 and 126,734 individuals were diagnosed with incident dementia during the follow-up period.
Those who suffered at least 1 traumatic brain injury were 24% more likely to be diagnosed with dementia than those without such a history, and 16% more likely to have Alzheimer’s disease diagnosed.
Moreover, factors such as increased number and increased severity of traumatic brain injuries sustained, increased the risk of dementia, inferring a cumulative effect. The risk of dementia in individuals who had suffered 5 or more injuries was almost 3-fold. Nevertheless, a single, mild injury (e.g. concussion) was linked to a 17% higher risk of dementia.
In the first 6 months after traumatic brain injury occurred, the researchers found the risk of dementia to be at its greatest, with risk decreasing thereafter. Also, younger victims of traumatic brain injuries appeared to face a higher risk of onset dementia. Those who suffered injuries in their 20s were 63% more likely to develop dementia than those who had not.
Dr Carol Routledge, Director of Research at Alzheimer’s Research UK, praised the latest study for being ‘well-conducted’, but noted that the ‘study only looked at head injuries that required hospital treatment and doesn’t tell us anything about the impacts you’d normally expect to see on the sports field’.
According to Professor Jonathan Schott, Professor of Neurology at University College London (UCL), the latest study is ‘perhaps the best evidence yet that traumatic brain injury is a risk factor for dementia’. Like Dr Routledge, however, Professor Schott identified that ‘further research is required to establish the extent to which specific types of head injury (e.g. sports concussions) are or are not implicated’.
The Football Association will undoubtedly be aware of this study and may choose to conduct more specific research on how specific types of head injury affect onset dementia.
[i] Jeremy Wilson, ‘Revealed: The second British footballer to die with head trauma’ (6 August 2018 The Telegraph) <https://www.telegraph.co.uk/football/2018/08/06/revealed-second-british-footballer-die-head-trauma/> accessed 15 August 2018.
[ii] Professor Jesse R Fann, MD, et al, ‘Long-term risk of dementia among people with traumatic brain injury in Denmark: a population-based observational cohort study’ (2018) DOI: 10.1016/S2215-0366(18)30065-8 <https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(18)30065-8/fulltext> accessed 2015 August 2018.
[iii] Miriam Stoppard, ‘Dr Miriam Stoppard: A knock to the head can lead to dementia’ (13 May 2018 Mirror) <https://www.mirror.co.uk/lifestyle/health/dr-miriam-stoppard-knock-head-12529024> accessed 15 August 2018.
[iv] ‘Concussion in 20s could increase the risk of dementia by 60 per cent, Lancet study finds’ <https://www.telegraph.co.uk/news/2018/04/10/concussion-20s-could-increase-risk-dementia-60-per-cent-lancet/> accessed 15 August 2018.