Concussion and long term cognitive function among rugby players – the BRAIN Study

Valentina Gallo, Damien McElvenny, Giulia Seghezzo, Simon Kemp, Elizabeth Williamson, Kirsty Lu, Saba Mian, Laura James, Catherine Hobbs, Donna Davoren, Nigel Arden, M.A.M. Davies, Andrea Malaspina, Michael Loosemore, Keith Stokes, Matthew Cross, Sebastian Crutch, Henrik Zetterberg, Neil Pearce

Research output: Contribution to journalArticlepeer-review

18 Citations (SciVal)

Abstract

Objective: The BRAIN Study was established to assess the associations between self-reported concussions and cognitive function among retired rugby players. Methods: Former elite-level male rugby union players (50+ years) in England were recruited. Exposure to rugby-related concussion was collected using the BRAIN-Q tool. The primary outcome measure was the Preclinical Alzheimer Cognitive Composite (PACC). Linear regressions were conducted for the association between concussion and PACC score, adjusting for confounders. Results: A total of 146 participants were recruited. The mean (standard deviation) length of playing career was 15.8 (5.4) years. A total of 79.5% reported rugby-related concussion(s). No association was found between concussion and PACC (β –0.03 [95% confidence interval (CI): –1.31, 0.26]). However, participants aged 80+ years reporting 3+ concussions had worse cognitive function than those without concussion (β –1.04 [95% CI: –1.62, –0.47]). Conclusions: Overall there was no association between concussion and cognitive function; however, a significant interaction with age revealed an association in older participants
Original languageEnglish
Pages (from-to)1164-1176
Number of pages13
JournalAlzheimer's & Dementia
Volume18
Issue number6
Early online date20 Oct 2021
DOIs
Publication statusPublished - 30 Jun 2022

Acknowledgements

We are grateful to all the BRAIN study participants for the time, interest, and commitment they have shown in contributing to the data collection. Thank you to the Rugby Football Union for their continued support with recruitment. We would like to thank Prof Carol Brayne who has provided very valuable input on each of the phases of the BRAIN study by chairing the BRAIN study Independent Oversight Committee (IOC). Thanks also to the IOC Members for their invaluable advice and guidance throughout: Bill Treadwell, Simon Jones, Dr. Collette Griffin, Professor Sinead Langan, Tim Lindsay, Hannah Wilson, and Tim Stevens. We also would like to thank Dr Ioannis Basinas for coding the job description for the statistical analysis; Dr James Van Santen and all the collaborators from the Centre for Sport, Exercise and Osteoarthritis Versus Arthritis study at University of Oxford who provided invaluable support in recruiting participants and interpreting data; Mr Joel Winston, Dr Vittoria Lombardi, and the other collaborators at Queen Mary University of London; Dr Hannah Whiteman, Dr Alexandra Anderson, Dr Heiner Grosskurth, Dr Jennifer Nicholas, Mr James Barr, Dr Peter Wright, and the other collaborators at London School of Hygiene and Tropical Medicine; Professor John Hardy at UCL, J Scott (UCL) and M Richards (UCL); Dr Mark Batt, Nottingham University for facilitating with Oxford; and with thanks to the clinics, Institute of Sport and Exercise Health, Manchester Institute of Health & Performance, University of Bath, Liverpool John Moores University and the University of Bristol. This study was funded by the Drake Foundation as part of the BRAIN study funded to London School of Hygiene and Tropical Medicine (EPMSZJ20-10) in collaboration with Queen Mary University of London and the Institute of Occupational Medicine. The funder had no role in the preparation of the manuscript, which has been written by the co-authors completely independently.

Funding

This study was funded by a grant from the Drake Foundation (www.drakefoundation.org/) to the London School of Hygiene and Tropical Medicine (EPMSZJ20), with subcontracts to Queen Mary University of London (QMUL) and the Institute of Occupational Medicine (IOM). The Drake Foundation supported this study with a grant awarded to the London School of Hygiene and Tropical Medicine to NP, VG, and DM. GS, SM, CH, and LJ were paid off the grant. All co‐authors are co‐investigators of the BRAIN Study. SK is employed by the Rugby Football Union as their Medical Services Director; SM and CH were paid out of the research grant; MD received also funds from the Rugby Football Union, and the Centre for Sport, Exercise and Osteoarthritis Versus Arthritis. Support received outside the submitted work: VG, NP, and DM received another grant from the Drake Foundation (2018‐2020) awarded to the London School of Hygiene and Tropical Medicine. VG received grants from Barts and The London Charity (2019‐2020), UKRI‐GCRF MRC‐CONCYTEC (2019 2022), and the London International Development Centre (2018‐19) all through her institution. DM received grants from the Brazilian Steel Institute, Kingspan Health and Safety Executive Aarhus University Hospital, Emirates Global Aluminium Guys, and St Thomas’ University Hospital, through his institution. EW received grants from MRC and NIHR, both unrelated to present work and through her institution. MD received support from the British Medical Association, the Rugby Football Union, the Rugby Football Union's Injured Players Foundation, and the British Horseracing Association, all through her institution. AM received grants from Barts Charity (2021 – 20250): Integrative bioinformatics analysis of fluid‐tissue proteomics to develop an ALS predictive model for biomarkers and therapeutic targets discovery. £184,194.40 (2019 – 2023) Barts and the London Charity, UCB Pharma SPRL. NIH (2018‐2022) Immunoreactivity to neurofilaments: therapeutics and biomarkers for ALS. £ 133,769. NIH (2022) Pre‐Symptomatic ALS Prelude to a Disease Prevention Trial. NIH‐ 95258, $ 215, 851 2018. NIH Clinical trial readiness in ALS National Institutes of Health – USA, NIH‐U01 Multi‐PI grant award. $ 367,372. All payments have been made to his institution. KS received money from Rugby Football Union, England Rugby Injury and Training Audit (2019‐2023); Rugby Football Union, Community Rugby Injury Surveillance Project (2017‐21): Community, Schools and Universities, (2017‐2021) Arthritis Research UK, ARUK Centre Renewal (2018‐2023); RFU Injured Players Foundation, Spinal Cord Injury Surveillance in Rugby, (2012‐2021); The Racing Foundation, Analysis of Spinal Injuries in Horseracing, (2020‐2023); British Horseracing Authority, Covid‐19 Surveillance in Racing, (2020‐2021); World Rugby, The contribution of in‐game fatigue and use of replacements to injury risk in professional rugby union, (2020‐2021). SC received funds from the Economic and Social Research Council & National Institute for Health Research Grant/Award Number: ES/S010467/1 as a principal investigator through his institution. HZ is a Wallenberg Scholar supported by grants from the Swedish Research Council (#2018‐02532), the European Research Council (#681712), Swedish State Support for Clinical Research (#ALFGBG‐720931), the Alzheimer Drug Discovery Foundation (ADDF), USA (#201809‐2016862), the AD Strategic Fund and the Alzheimer's Association (#ADSF‐21‐831376‐C, #ADSF‐21‐831381‐C and #ADSF‐21‐831377‐C), the Olav Thon Foundation, the Erling‐Persson Family Foundation, Stiftelsen för Gamla Tjänarinnor, Hjärnfonden, Sweden (#FO2019‐0228), the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska‐Curie grant agreement No 860197 (MIRIADE), and the UK Dementia Research Institute at UCL. All payments made to institution. HZ has served at scientific advisory boards and/or as a consultant for Alector, Eisai, Denali, Roche Diagnostics, Wave, Samumed, Siemens Healthineers, Pinteon Therapeutics, Nervgen, AZTherapies, CogRx and Red Abbey Labs. Payments made to himself. NP received grants for other research, all unrelated to this paper. In addition, NA received consultancy fees from Pfizer/Lilly 2018; Bristows LLP 2019; and Novartis 2021 with payments directed to himself. AM received consultancy fee from Cross‐molecule Advisory Board in Neurofilaments (NfL), and Hoffmann‐La Roche Ltd with payment made to himself. SC has received consultancy fees from the Wellcome Trust, payment to himself. HZ has served at scientific advisory boards and/or as a consultant for Alector, Eisai, Denali, Roche Diagnostics, Wave, Samumed, Siemens Healthineers, Pinteon Therapeutics, Nervgen, AZTherapies, CogRx, and Red Abbey Labs. Payments made to HZ. EW received payment for providing training to AstraZeneca, unrelated to current work. AM received payment from Pfizer: for “Disease progression in ALS: cell senescence and metabolism in the driving seat,” lecture. SC received a Siriraj International Visiting Scholar at the Division of Neurology, Department of Medicine, Bangkok, Thailand to himself. HZ has given lectures in symposia sponsored by Cellectricon, Fujirebio, Alzecure and Biogen. Payments made to HZ. DM received a small number of testimonies provided for both claimants and defendants. All payments were to his institution. AM patented with Prof. M. Benatar “Determining onset of amyotrophic lateral sclerosis.” Patent number: B75649EPD40021. SK participated in WADA TUE Expert Group (Honorary) UKAD Innovation and Research Group (Honorary) FA Expert Concussion Panel (Honorary) FIFA Expert Concussion Panel (Honorary) World Rugby Concussion Working Group (Honorary) Chair Ineos Cycling Medical Advisory Group (Paid Personally). Finally, VG is member of the Ethical Committee at Campus Fryslân, since April 2020; member of the Selection Committee of the Young Academy Groningen–University of Groningen, since 2021, editor of since January 2020, member of the Industrial Injury Advisory Committee from November 1st 2018 to January 2020 (for this last role, she received personal compensation). HZ is a chair of the Alzheimer's Association Global Biomarker Standardization Consortium and the AA Biofluid‐Based Biomarker PIA. No payments made. HZ is a co‐founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program. Payments made to HZ. CH received a PhD studentship funded by the GW4 Medical Research Council BioMedical Doctoral Training Partnership at the University of Bath; her Research Associate position at the University of Bristol is funded by the Elizabeth Blackwell Institute for Healthcare Research and Rosetrees Trust. KL and MC have nothing to disclose and report no conflicts of interest. Journal of Neurology

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