Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK.
JAMA Netw Open. 2023 Jul 3;6(7):e2323822. doi: 10.1001/jamanetworkopen.2023.23822.
Although professional soccer players appear to be at higher risk of neurodegenerative disease, the reason remains unknown.
To examine whether heading frequency is associated with risk of cognitive impairment in retired professional soccer players.
DESIGN, SETTING, AND PARTICIPANTS: A UK nationwide cross-sectional study was conducted between August 15, 2020, and December 31, 2021, in 459 retired male professional soccer players older than 45 years and registered with the Professional Footballers' Association or a League Club Players' Association.
Data on heading frequency in 3 bands-0 to 5, 6 to 15, and more than 15 times per match or training session and other soccer-specific risk factors, such as player position and concussion-were collected through a self-reported questionnaire.
Cognitive impairment was defined using the Telephone Interview for Cognitive Status-modified as scores of less than or equal to 21. Hopkins Verbal Learning Test, verbal fluency, and independent activities of daily living were also assessed. Test Your Memory and physician-diagnosed dementia/Alzheimer disease were self-reported via the questionnaire. Adjusted odds ratios (AORs) with 95% CIs were calculated.
Of 468 retired male professional soccer players who completed questionnaires (mean [SD] age, 63.68 [10.48]; body mass index, 27.22 [2.89]), 459 reported heading frequency: 114 headed 0 to 5 times, 185 headed 6 to 15 times, 160 headed more than 15 times per match, and 125 headed 0 to 5 times, 174 headed 6 to 15 times, and 160 headed more than 15 times per training session during their careers. The prevalence of cognitive impairment was 9.78% (0-5 times), 14.78% (6-15 times), and 15.20% (>15 times) per match (P = .51). Compared with players reporting 0 to 5 headers per match, the AORs were 2.71 (95% CI, 0.89-8.25) for players reporting 6 to 15 headers per match and 3.53 (95% CI, 1.13-11.04) for players reporting more than 15 headers per match (P = .03 for trend). Corresponding AORs for heading frequency per training session were 2.38 (95% CI, 0.82-6.95) for those reporting 6 to 15, and 3.40 (95% CI, 1.13-10.23) for those reporting more than 15 in comparison with those who reported 0 to 5 (P = .03 for trend). Concussion involving memory loss was also associated with a greater risk of cognitive impairment (AOR, 3.16; 95% CI, 1.08-9.22). Similar results were observed with other cognitive tests and self-reported physician-diagnosed dementia/Alzheimer disease.
The findings of this study suggest that repetitive heading during a professional soccer career is associated with an increased risk of cognitive impairment in later life. Further study is needed to establish the upper threshold for heading frequency to mitigate this risk.
尽管职业足球运动员似乎面临更高的神经退行性疾病风险，但原因仍不清楚。
研究在退役职业足球运动员中，头部撞击频率是否与认知障碍风险相关。
设计、地点和参与者：这是一项在 2020 年 8 月 15 日至 2021 年 12 月 31 日期间在英国进行的全国性横断面研究，参与者为 459 名年龄大于 45 岁、登记在职业足球运动员协会或联赛俱乐部球员协会的退役男性职业足球运动员。
通过自我报告问卷收集了头部撞击频率在 3 个频段（0 到 5 次、6 到 15 次和 15 次以上/次比赛或训练）和其他特定于足球的风险因素的数据，如球员位置和脑震荡。
使用电话访谈认知状态修改版（得分为等于或小于 21 分）来定义认知障碍。还评估了霍普金斯言语学习测试、言语流畅性和独立日常生活活动。通过问卷自我报告测试你的记忆和医生诊断的痴呆/阿尔茨海默病。
调整后的优势比（AOR）及其 95%置信区间计算。
在完成问卷的 468 名退役男性职业足球运动员中（平均[SD]年龄 63.68[10.48]；体重指数 27.22[2.89]），459 人报告了头部撞击频率：114 人 0 到 5 次，185 人 6 到 15 次，160 人超过 15 次/比赛；125 人 0 到 5 次，174 人 6 到 15 次，160 人超过 15 次/训练。认知障碍的患病率为 0-5 次撞击时为 9.78%，6-15 次撞击时为 14.78%，超过 15 次撞击时为 15.20%（P=0.51）。与报告 0-5 次撞击的球员相比，报告 6-15 次撞击的 AOR 为 2.71（95%CI，0.89-8.25），报告超过 15 次撞击的 AOR 为 3.53（95%CI，1.13-11.04）（趋势 P=0.03）。对于撞击频率报告 6-15 次和超过 15 次/训练的 AOR 分别为 2.38（95%CI，0.82-6.95）和 3.40（95%CI，1.13-10.23）（趋势 P=0.03）。涉及记忆丧失的脑震荡也与认知障碍的风险增加相关（AOR，3.16；95%CI，1.08-9.22）。其他认知测试和自我报告的医生诊断痴呆/阿尔茨海默病也观察到类似的结果。
这项研究的结果表明，职业足球生涯中的重复性头部撞击与晚年认知障碍的风险增加有关。需要进一步的研究来确定头部撞击频率的上限，以降低这种风险。
