Clinical Scorecard: Cognitive and Clinical Profiles of Brain Health Issues in Retired Rugby Athletes

At a Glance

Key Highlights

• Former elite rugby players report significant symptom burden including depression, anxiety, and post-concussion symptoms, especially those with higher self-reported concussions.
• Objective cognitive impairments and TES diagnosis are relatively uncommon in mid-life former players; no cases of dementia were identified.
• Structural MRI showed increased prevalence of cavum septum pellucidum in players with higher concussion exposure compared to controls.

Guideline-Based Recommendations

Diagnosis

• Use research diagnostic criteria for traumatic encephalopathy syndrome (TES) incorporating clinical phenotypes of neurobehavioral dysregulation and cognitive impairment.
• Assess concussion history, career duration, and player position alongside symptom scales and cognitive testing.
• Employ 3T MRI to identify structural brain changes such as cavum septum pellucidum.

Management

• Focus on symptom management for depression, anxiety, and post-concussion symptoms in former players.
• No current evidence supports dementia-specific interventions in this mid-life population.
• Consider multidisciplinary approaches addressing neuropsychiatric symptoms and executive dysfunction.

Monitoring & Follow-up

• Regular clinical follow-up to monitor symptom progression and cognitive status.
• Use self and informant ratings to track neuropsychiatric symptoms and executive function behaviors.
• Monitor for emergence of motor signs or psychiatric features supportive of TES diagnosis.

Risks

• Higher self-reported concussion count is associated with increased symptom burden and TES classification.
• Forwards and players with more concussions are at greater risk of neurobehavioral disturbances.
• No direct correlation found between years of play or player position and symptom severity.

Patient & Prescribing Data

Mid-life former elite rugby players with brain health concerns and history of repetitive head impacts

Symptom burden is higher in those with greater concussion history; cognitive impairment is uncommon, suggesting treatment focus on neuropsychiatric symptoms rather than dementia.

Clinical Best Practices

• Obtain detailed concussion history and career exposure data in former rugby players presenting with brain health concerns.
• Utilize standardized symptom rating scales for depression, anxiety, post-concussion symptoms, and executive dysfunction.
• Apply research criteria for TES to identify individuals at risk of CTE pathology.
• Incorporate neuroimaging to detect structural abnormalities associated with repetitive head trauma.
• Provide multidisciplinary symptom management tailored to individual neurobehavioral and psychiatric profiles.

References

• McKee AC et al., Neuropathology of chronic traumatic encephalopathy
• Montenigro PH et al., Clinical subtypes of traumatic encephalopathy syndrome
• Gardner AJ et al., Risk of neurodegenerative disease in former rugby players