The association between concussions in American football and dementia

Concussion is typically described as a complex pathophysiological process affecting the brain, resulting from trauma or injury that is induced by biomechanical forces (McCrory et al., 2017). The impacts on the cerebrum associated with concussion can be particularly damaging and are linked to a lower life-expectancy (Gould, 2012), and can be fatal if not treated adequately (Amen et al., 2011). Each concussion is entirely unique and similarly, the side effects range significantly in different individuals. For example, cerebral pains, sluggishness, and memory loss may happen immediately, or in the days following the initial injury.


The risk of concussion is particularly high in American football players (Clay, Glover and Lowe, 2013). This increased prevalence, has meant concussions within the Nation Football League (NFL) and collegiate level football has become the centre of considerable attention since the mid 1990’s; termed by Harrison (2014) as ‘The Concussion Crisis’. In response, the principal ‘Mind Injury Committee’ was established in 1994 for the NFL (Ezell, 2020) aiming to XXXXXXX?. However, statistics for the number of the concussions in the NFL only date back to as recent as 2012, where 261 cases were recorded. A focal point and an area which received attention a century ago as a clinical issue among young individuals playing football, is now gaining attention by top universities and is currently a major issue of general wellbeing across all levels of play. The concussion rate in the NFL has diminished since 2012, although 2017 had the greatest number of cases, recording 281 competitors reported as experiencing concussions (Casson, Viano, Powell and Pellman, 2010).


Despite the relatively recent interest in concussion in football, there is evidence of early reporting of concussions back to 1883. In 1894, Penn footballer William Harvey expressed “the main genuine injury I got was in the game with Harvard in 1883”. He also made the following statement “when in a scrimmage behind the objective I was tackled, however retained awareness in around fifteen minutes.” (Harrison, 2014).  DE – if this is a direct quote add the page numbers its from? This early documentation of concussion emergency in football highlights basic issues related to the type of arrangements instituted or if any arrangements were established for when these events occurred. Concussions in American football, which is a sport widely participated in among youth, secondary schools, universities, and on professional levels, is one small aspect of a much larger current issue relating to head injury in sports (Harrison, 2014).



Concussions in other sports.


When comparing the rates of concussion within football to other sports such as rugby, some fascinating results were drawn. A recent systematic review (Concussion Rate, 2020) which analysed the concussion rate in group activities, found that men’s rugby was found to have the most noteworthy rate of concussions in both match play (3.00/1,000 athletic exposure, AE) and practice (0.37/1,000 AE). These findings are not unexpected, given that as rugby players unlike NFL players do not wear any protective head gear during competitive match play or practice.


While investigating concussive head traumas within the previous 20 years, data shows that the frequency of these concussions have increased significantly (Cantu, 2006). However, it cannot be determined from these data how many of these individuals experimented multiple concussions. Macciocchi, Barth, Littlefield and Cantu, (2001) carried out a study with athletes who sustained one versus two concussions in competitive endeavours. They found that the impacts of two head collisions did appear to be greater than that of a solitary head injury. The neurocognitive and neurobehavioral outcomes of two concussions did not have all the earmarks of being essentially unique in relation to those of one concussion.