Cognitive and Clinical Profiles of Brain Health in Retired Rugby Athletes
Overview
This study assessed 200 former elite rugby players with brain health concerns, revealing elevated neuropsychiatric symptoms and executive dysfunction compared to controls, particularly in those with higher self-reported concussions. Despite frequent subjective memory complaints, objective cognitive impairments and dementia were uncommon, and only 12% met criteria for traumatic encephalopathy syndrome (TES).
Background
Rugby is a collision sport linked to repetitive head impacts (RHI) and increased risk of traumatic brain injury (TBI). Epidemiological data indicate former rugby players have higher rates of neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), a pathology associated with RHI. Clinical diagnosis of CTE is challenging, with traumatic encephalopathy syndrome (TES) proposed as its clinical correlate. Prior to this study, detailed clinical characterization of former rugby players with brain health concerns was lacking.
Data Highlights
Measure
Former Rugby Players (n=200)
Controls (n=33)
Median Age (years)
44
Not specified
Male (%)
90.5%
Not specified
Median Career Length (years)
10.5
Not applicable
Median Self-Reported Concussions
7
Not applicable
Forwards (%)
63%
Not applicable
Backs (%)
37%
Not applicable
TES Diagnosis (%)
12% (24 players)
0%
Cavum Septum Pellucidum Visible (%)
24%
12%
Cavum Septum Pellucidum in High Concussion Group (%)
32%
Not applicable
Cavum Septum Pellucidum in Low Concussion Group (%)
16%
Not applicable
Key Findings
Former rugby players reported significantly higher depressive, anxiety, post-concussion, neuropsychiatric, and executive dysfunction symptoms compared to controls, except for sleep quality.
Objective cognitive testing showed no significant differences between former players and controls; no cases of dementia were identified.
TES was diagnosed in 24 former players (12%), with subtypes including cognitive impairment, neurobehavioral dysregulation, or both.
Forwards and players with more self-reported concussions were more likely to have TES characterized by neurobehavioral symptoms.
Symptom burden correlated with concussion history but was unrelated to career length or player position.
Cavum septum pellucidum, a structural brain feature, was more prevalent in former players, especially those with higher concussion exposure.
Clinical Implications
Clinicians should be aware that former elite rugby players in mid-life may present with significant neuropsychiatric and behavioral symptoms related to concussion history, even in the absence of objective cognitive impairment or dementia. TES diagnosis is relatively uncommon but should be considered in symptomatic individuals, particularly those with multiple concussions. Structural imaging findings such as cavum septum pellucidum may support clinical assessment but are not diagnostic alone.
Conclusion
Former elite rugby players exhibit a complex clinical profile with elevated symptom burden linked to concussion exposure, yet objective cognitive deficits and dementia remain rare in mid-life. These findings underscore the need for nuanced clinical evaluation and targeted interventions addressing neurobehavioral symptoms in this population.
References
Original Article 2024 -- Cognitive and Clinical Profiles of Brain Health Issues in Retired Rugby Athletes
by Thomas D Parker, Jessica A Hain, Erin J Rooney, Karl A Zimmerman, Ying Lee, Martina Del Giovane, Neil S N Graham, Maneesh Patel, Adam Hampshire, Mathew G Wilson, Daniel Friedland, David J Sharp, Richard J Sylvester
In a target-trial emulation of more than 600,000 veterans, GLP-1 RA initiators saw fewer new substance use disorders—and patients with existing SUDs had fewer overdoses, hospitalizations, and deaths.
