Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players

Great paper by dear friend and colleague Helen Ling... this is one of the strongest indications yet that repetitive head trauma is a risk factor for neuro-degeneration... in this instance it has been suggested in professional footballers who have headed the ball repeatedly... Clearly this does not provide definitive evidence but it is nonetheless a very important paper and one that has great public health importance... However this topic clearly divides people, including doctors... there will be thousands of people that get dementia and parkinsonism that never played football and vice versa thousands of footballers that don't get these diseases during their lives... a selection of media links so that you can see different interpretations...

http://www.bbc.co.uk/news/health-38971750
http://news.sky.com/story/football-in-denial-over-link-between-heading-and-brain-injury-10768739
http://www.independent.co.uk/sport/football/news-and-comment/dementia-in-football-heading-fa-pfa-footballers-head-injury-a7580496.html
http://www.dailymail.co.uk/health/article-4225776/Heading-football-raises-risk-dementia.html

Acta Neuropathologica
Helen Ling, Huw R. Morris, James W. Neal, Andrew J. Lees, John Hardy, Janice L. Holton, Tamas Revesz, David D. R. Williams

http://link.springer.com/article/10.1007/s00401-017-1680-3/fulltext.html

In retired professional association football (soccer) players with a past history of repetitive head impacts, chronic traumatic encephalopathy (CTE) is a potential neurodegenerative cause of dementia and motor impairments. From 1980 to 2010, 14 retired footballers with dementia were followed up regularly until death. Their clinical data, playing career, and concussion history were prospectively collected. Next-of-kin provided consent for six to have post-mortem brain examination. Of the 14 male participants, 13 were professional and 1 was a committed amateur. All were skilled headers of the ball and had played football for an average of 26 years. Concussion rate was limited in six cases to one episode each during their careers. All cases developed progressive cognitive impairment with an average age at onset of 63.6 years and disease duration of 10 years. Neuropathological examination revealed septal abnormalities in all six post-mortem cases, supportive of a history of chronic repetitive head impacts. Four cases had pathologically confirmed CTE; concomitant pathologies included Alzheimer’s disease (N = 6), TDP-43 (N = 6), cerebral amyloid angiopathy (N = 5), hippocampal sclerosis (N = 2), corticobasal degeneration (N = 1), dementia with Lewy bodies (N = 1), and vascular pathology (N = 1); and all would have contributed synergistically to the clinical manifestations. The pathological diagnosis of CTE was established in four individuals according to the latest consensus diagnostic criteria. This finding is probably related to their past prolonged exposure to repetitive head impacts from head-to-player collisions and heading the ball thousands of time throughout their careers. Alzheimer’s disease and TDP-43 pathologies are common concomitant findings in CTE, both of which are increasingly considered as part of the CTE pathological entity in older individuals. Association football is the most popular sport in the world and the potential link between repetitive head impacts from playing football and CTE as indicated from our findings is of considerable public health interest. Clearly, a definitive link cannot be established in this clinico-pathological series, but our findings support the need for further systematic investigation, including large-scale case–control studies to identify at risk groups of footballers which will justify for the implementation of protective strategies.