Running head: LONG TERM EFFECTS OF CONCUSSIONS 1

Long Term Effects of Sports Related Concussions

Lauren Suggs

University of North Florida

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Traumatic brain injuries (TBIs) are an important public health concern. From 2007 to

2013, the rates of TBI-related emergency department visits increased by 47% (Centers for

Disease Control and Prevention [CDC], 2017). Each year, about 75% of TBIs that occur are

concussions or other forms of mild TBI (CDC, 2006). Furthermore, the Brain Injury Research

Institute (n.d) suggested that between 1.6 and 3.8 million sports related concussions occur each

year. The Centers for Disease Control and Prevention (2017), the National Safety Council (n.d),

and many other organizations report that concussions are a serious concern to public health.

According to Moore, Hillman, and Broglio (2014) and De Beaumont, Theoret et al.

(2009), sports related concussions have traditionally been regarded as transient injury, therefore

research has focused on their immediate effects. However, research is now focused on potential

long term effects of sports related concussions. The aim of this review is to determine if there is

an association between concussions and future cognitive and neurological functioning in former

and current adult athletes in North America. If an athlete sustains a concussion, then they are

expected to experience declines in future cognitive and neurological functioning.

The articles reviewed show an overwhelming association between sports related

concussions and a decline in cognitive and neurological functioning. One study conducted by

Guskiewicz et al. in 2005, has served as a reference for many of the more recent studies

completed due to its large sample sample size. Guskiewicz et al. (2005) conducted a cross-

sectional study to assess the association between previous concussion and the likelihood of

developing mild cognitive impairment (MCI) or Alzheimer’s Disease (AD) in a group of retired

national football league players in the United States. The researchers sent out questionnaires and

received almost 2000 responses but used around 800 in their final analysis. The data revealed an

earlier onset of AD in the previously concussed athletes than that which occurs in the general
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American male population. However, an association between the number of concussions and a

diagnosis of AD was not found. Further analysis of the data showed an association between

repeated concussions and clinically diagnosed MCI, self-reported significant memory

impairment, and relative-reported significant memory impairment. More specifically, the data

showed that players with three or more concussions had a five-fold prevalence of being

diagnosed with MCI and a three-fold prevalence of reported significant memory problems

compared to players without a history of concussions. The study concluded that a history of

concussions could be a risk factor for late-life memory impairment, AD, and MCI. Similar to

Guskiewicz et al. (2005), Moore et al. (2014) used a cross-sectional study design to explore the

effects of previous sports concussions on cognitive function but focused more broadly on

neuroelectric function. Data collected by Moore et al. (2014) revealed that previously concussed

athletes exhibited persistent reductions in neurocognitive function, as demonstrated by reduced

response accuracy, decreased allocation of attentional resources, and amplified stimulus-

response conflict in tasks involving variable amounts of cognitive control. In addition to

decreased cognitive function, the retired athletes also displayed neuroelectric deficits. The

researchers determined that sports related concussion chronically damage higher-order

neurocognition by damaging attention, working memory, inhibition, and interference control.

De Beaumont, Theoret et al. (2009) also studied cognitive function but took a different

approach to neurological function by examining changes in motor function. De Beaumont,

Theoret et al. (2009) found that compared to the control group, those who sustained a previous

concussion showed reductions on neuropsychological and electrophysiological measures of

episodic memory and frontal lobe functions which are known for sensitivity to MCI and early-

onset AD. The previously concussed group also displayed significantly slower motor execution
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compared to the control group. In another study, De Beaumont et al. (2011) focused specifically

on motor control by assessing concussion-related changes of motor system function in previously

concussed athletes. The data from this study revealed that sports concussions are associated with

pervasive changes in postural control and primary cortex intracortical inhibition. The findings

provided evidence of neurophysiological and behavioral evidence of enduring, subclinical

changes in motor system integrity.

Different from the previous studies discussed, Goswami et al. (2016) concentrated on

behavior changes due to neurological alterations. Goswami et al. (2016) used a case control

study design to reveal that previously concussed athletes had increased mania and aggression

relative to controls. The concussed group demonstrated OFC thickness and UF axial diffusivity

on MRI scans which is correlated with task error and aggression.

Each study reviewed exhibited a positive association between concussions and long term

impacts in athletes. However, they were all different in several ways as well. Both Guskiewicz et

al. (2005) and Moore et al. (2009) conducted a cross-sectional study in the United States.

Whereas Goswami et al. (2016), De Beaumont and Theoret (2009), and De Beaumont et al.

(2011) conducted a case-control study in Canada. Moreover, the studies varied in the types of

athletes they used. Goswami et al. (2016), De Beaumont and Theoret et al. (2009), and

Guskiewicz used former athletes; De Beaumont et al. (2011), used current athletes; and Moore et

al. (2014) used current and former athletes. Each article also used various form of complicated

testing methods to obtain their results. Each article used at least one questionnaire in some form.

De Beaumont, Theoret et al. (2009), and Moore et al. (2014) both used event related potentials

and oddball paradigms in their assessments. Goswami et al. (2016) was unique from the other

articles as they used MRI scans to measure ATL thinning and OFC thickness.
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The goal of this review was to determine if an association exists between sports related

concussions and future cognitive and neurological functioning. All of the literature reviewed,

revealed that sports related concussion led to a decline in cognitive and neurological function in

athletes in North America. The association between sports related concussions and future

cognitive and neurological functioning poses alarm to public health professionals. The popularity

of sports in North America exposes a large number of athletes to potential brain injury and long

term impacts. Public health professionals are already working to increase awareness and

decrease risk in various ways. The CDC (2004) has released a campaign called “Heads Up:

Concussion in High School Sport” to educate coaches on how to prevent, recognize, and manage

sports related concussions. There are already some guidelines in place for high school, collegiate,

and professional sports on returning to play after a significant blow to the head or concussion. In

the future, public health professionals should work on developing protocols and suggestions on

returning to play after multiple sports related concussions.

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References

Centers for Disease Control and Prevention. (2004). Heads Up. Retrieved from

https://www.cdc.gov/headsup/index.html

Centers for Disease Control and Prevention. (2006). Get the Stats on Traumatic Brain Injury in

the United States. Retrieved from

https://www.cdc.gov/traumaticbraininjury/pdf/bluebook_factsheet-a.pdf

Centers for Disease Control and Prevention. (2017). Traumatic Brain Injury & Concussion.

Retrieved from https://www.cdc.gov/traumaticbraininjury/outcomes.html

De Beaumont, L., Mongeon, D., Tremblay, S., Messier, J., Prince, F., Leclerc, S., et al. (2011).

Persistent motor system abnormalities in formerly concussed athletes. Journal of Athletic

Training, 46(3), 234.

De Beaumont, L., Théoret, H., Mongeon, D., Messier, J., Leclerc, S., Tremblay, S., et al. (2009).

Brain function decline in healthy retired athletes who sustained their last sports

concussion in early adulthood. Brain, 132(3), 695-708. doi:10.1093/brain/awn347

Goswami, R., Dufort, P., Tartaglia, M., Green, R., Crawley, A., Tator, C., et al. (2016).

Frontotemporal correlates of impulsivity and machine learning in retired professional

athletes with a history of multiple concussions. Brain Structure and Function, 221(4),

1911-1925. doi:10.1007/s00429-015-1012-0

Guskiewicz, K. M., Marshall, S. W., Bailes, J., McCrea, M., Cantu, R. C., Randolph, C., et al.

(2005). Association between recurrent concussion and late-life cognitive impairment in

retired professional football players. Neurosurgery, 57(4), 719.

doi:10.1093/neurosurgery/57.4.719
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Moore, R. D., Hillman, C. H., & Broglio, S. P. (2014). The persistent influence of concussive

injuries on cognitive control and neuroelectric function. Journal of Athletic

Training, 49(1), 24-35. doi:10.4085/1062-6050-49.1.01

National Safety Council. (n.d). Concussion care belongs at the top of every youth sports

playbook. Retrieved from https://www.nsc.org/home-safety/safety-topics/child-

safety/concussions

The Brain Injury Research Institute. (n.d). What Is A Concussion?. Retrieved from

http://www.protectthebrain.org/Brain-Injury-Research/What-is-a-Concussion-.aspx