Profile of Self-Reported Problems with Executive Functioning in College and Professional Football Players
Abstract
Repetitive mild traumatic brain injury (mTBI), such as that experienced by contact-sport athletes, has been associated with the development of chronic traumatic encephalopathy (CTE). Executive dysfunction is believed to be among the earliest symptoms of CTE, with these symptoms presenting in the fourth or fifth decade of life. The present study used a well-validated self-report measure to study executive functioning in football players, compared to healthy adults. Sixty-four college and professional football players were administered the Behavior Rating Inventory of Executive Function, adult version (BRIEF-A) to evaluate nine areas of executive functioning. Scores on the BRIEF-A were compared to published age-corrected normative scores for healthy adults Relative to healthy adults, the football players indicated significantly more problems overall and on seven of the nine clinical scales, including Inhibit, Shift, Emotional Control, Initiate, Working Memory, Plan/Organize, and Task Monitor. These symptoms were greater in athletes 40 and older, relative to younger players. In sum, football players reported more-frequent problems with executive functioning and these symptoms may develop or worsen in the fifth decade of life. The findings are in accord with a growing body of evidence that participation in football is associated with the development of cognitive changes and dementia as observed in CTE.
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References
1.
Faul M Z.L.Wald M.M.Coronado V.G.2010Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deathsCenters for Disease Control and Prevention, National Center for Injury Prevention and ControlAtlanta, GA. 1. Faul, M Z.L., Wald, M.M., and Coronado, V.G. (2010). Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control: Atlanta, GA.
2.
Control C.f.I.P.a.2003Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serous public health problemCenters for Disease Control and PreventionAtlanta, GA. 2. Control C.f.I.P.a. (2003). Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serous public health problem. Centers for Disease Control and Prevention: Atlanta, GA.
3.
Finkelstein E.Corso P.Miller T.2006The Incidence and Economic Burden of Injuries in the United StatesOxford University PressNew York. 3. Finkelstein, E., Corso, P., and Miller, T. (2006). The Incidence and Economic Burden of Injuries in the United States. Oxford University Press: New York.
4.
Dikmen S.S.Corrigan J.D.Levin H.S.Machamer J.Stiers W.Weisskopf M.G.2009. Cognitive outcome following traumatic brain injuryJ. Head Trauma Rehabil.24430-438. 4. Dikmen, S.S., Corrigan, J.D., Levin, H.S., Machamer, J., Stiers, W., and Weisskopf, M.G. (2009). Cognitive outcome following traumatic brain injury. J. Head Trauma Rehabil. 24, 430–438.
5.
Langlois J.A.Rutland-Brown W.Wald M.M.2006. The epidemiology and impact of traumatic brain injury: a brief overviewJ. Head Trauma Rehabil.21375-378. 5. Langlois, J.A., Rutland-Brown, W., and Wald, M.M. (2006). The epidemiology and impact of traumatic brain injury: a brief overview. J. Head Trauma Rehabil. 21, 375–378.
6.
Daneshvar D.H.Nowinski C.J.McKee A.C.Cantu R.C.2011. The epidemiology of sport-related concussionClin Sports Med.301-17, vii. 6. Daneshvar, D.H., Nowinski, C.J., McKee, A.C., and Cantu, R.C. (2011). The epidemiology of sport-related concussion. Clin Sports Med. 30, 1–17, vii.
7.
Hootman J.M.Dick R.Agel J.2007. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiativesJ. Athl. Train.42311-9. 7. Hootman, J.M., Dick, R., and Agel, J. (2007). Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J. Athl. Train. 42,311–9.
8.
Gessel L.M.Fields S.K.Collins C.L.Dick R.W.Comstock R.D.2007. Concussions among United States high school and collegiate athletesJ. Athl. Train.42495-503. 8. Gessel, L.M., Fields, S.K., Collins, C.L., Dick, R.W., and Comstock, R.D. (2007). Concussions among United States high school and collegiate athletes. J. Athl. Train. 42, 495–503.
9.
Promotion N.C.f.C.D.P.H.2006Behavioral risk factor surveillance system: exerciseCenters for Disease Control and PreventionAtlanta, GA. 9. Promotion N.C.f.C.D.P.H. (2006). Behavioral risk factor surveillance system: exercise: Centers for Disease Control and Prevention: Atlanta, GA.
10.
National Council of Youth Sports2008Report on Trends and Participation in Organized Youth SportsNational Council of Youth SportsStuart, FL. 10. National Council of Youth Sports. (2008) Report on Trends and Participation in Organized Youth Sports. National Council of Youth Sports: Stuart, FL.
11.
Gysland S.M.Mihalik J.P.Register-Mihalik J.K.Trulock S.C.Shields E.W.Guskiewicz K.M.2012. The relationship between subconcussive impacts and concussion history on clinical measures of neurologic function in collegiate football playersAnn. Biomed. Eng.4014-22. 11. Gysland, S.M., Mihalik, J.P., Register-Mihalik, J.K., Trulock, S.C., Shields, E.W., and Guskiewicz, K.M. (2012). The relationship between subconcussive impacts and concussion history on clinical measures of neurologic function in collegiate football players. Ann. Biomed. Eng. 40, 14–22.
12.
Omalu B.I.DeKosky S.T.Hamilton R.L.Minster R.L.Kamboh M.I.Shakir A.M.Wecht C.H2006. Chronic traumatic encephalopathy in a national football league player: part IINeurosurgery591086-1092discussion, 1092–1093. 12. Omalu, B.I., DeKosky, S.T., Hamilton, R.L., Minster, R.L., Kamboh, M.I., Shakir, A.M., and Wecht C.H. (2006). Chronic traumatic encephalopathy in a national football league player: part II. Neurosurgery 59, 1086–1092; discussion, 1092–1093.
13.
Omalu B.I.DeKosky S.T.Minster R.L.Kamboh M.I.Hamilton R.L.Wecht C.H.2005. Chronic traumatic encephalopathy in a National Football League playerNeurosurgery57128-134; discussion, 134. 13. Omalu, B.I., DeKosky, S.T., Minster, R.L., Kamboh, M.I., Hamilton, R.L., and Wecht, C.H. (2005). Chronic traumatic encephalopathy in a National Football League player. Neurosurgery 57, 128–134; discussion, 134.
14.
Omalu B.I.Hamilton R.L.Kamboh M.I.DeKosky S.T.Bailes J.2010. Chronic traumatic encephalopathy (CTE) in a National Football League Player: case report and emerging medicolegal practice questionsJ. Forensic Nurs.640-46. 14. Omalu, B.I., Hamilton, R.L., Kamboh, M.I., DeKosky, S.T., and Bailes, J. (2010). Chronic traumatic encephalopathy (CTE) in a National Football League Player: case report and emerging medicolegal practice questions. J. Forensic Nurs. 6, 40–46.
15.
McKee A.C.Cantu R.C.Nowinski C.J.Hedley-Whyte E.T.Gavett B.E.Budson A.E.Santini V.E.Lee H.S.Kubilus C.A.Stern R.A.2009. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injuryJ. Neuropathol. Exp. Neurol.68709-735. 15. McKee, A.C., Cantu, R.C., Nowinski, C.J., Hedley-Whyte, E.T., Gavett, B.E., Budson, A.E., Santini, V.E., Lee, H.S., Kubilus, C.A., and Stern, R.A. (2009). Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J. Neuropathol. Exp. Neurol. 68, 709–735.
16.
McKee A.C.Gavett B.E.Stern R.A.Nowinski C.J.Cantu R.C.Kowall N.W.Perl D.P.Hedley-Whyte E.T.Price B.Sullivan C.Morin P.Lee H.S.Kubilus C.A.Daneshvar D.H.Wulff M.Budson A.E.2010. TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathyJ. Neuropathol. Exp. Neurol.69918-929. 16. McKee, A.C., Gavett, B.E., Stern, R.A., Nowinski, C.J., Cantu, R.C., Kowall, N.W., Perl, D.P., Hedley-Whyte, E.T., Price, B., Sullivan, C., Morin, P., Lee, H.S., Kubilus, C.A., Daneshvar, D.H., Wulff, M., and Budson, A.E. (2010). TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy. J. Neuropathol. Exp. Neurol. 69, 918–929.
17.
Guskiewicz K.M.Marshall S.W.Bailes J.McCrea M.Cantu R.C.Randolph C.Jordan B.D.2005. Association between recurrent concussion and late-life cognitive impairment in retired professional football playersNeurosurgery57719-726; discussion, 726. 17. Guskiewicz, K.M., Marshall, S.W., Bailes, J., McCrea, M., Cantu, R.C., Randolph, C., and Jordan, B.D. (2005). Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery 57, 719–726; discussion, 726.
18.
Lehman E.J.Hein M.J.Baron S.L.Gersic C.M.2012. Neurodegenerative causes of death among retired National Football League playersNeurology121970-1974. 18. Lehman, E.J., Hein, M.J., Baron, S.L., and Gersic, C.M. (2012). Neurodegenerative causes of death among retired National Football League players. Neurology 12, 1970–1974.
19.
McKee A.C.Stern R.A.Nowinski C.J.Stein T.D.Alvarez V.E.Daneshvar D.H.Lee H.S.Wojtowicz S.M.Hall G.Baugh C.M.Riley D.O.Kubilus C.A.Cormier K.A.Jacobs M.A.Martin B.R.Abraham C.R.Ikezu T.Reichard R.R.Wolozin B.L.Budson A.E.Goldstein L.E.Kowall N.W.Cantu R.C.2013. The spectrum of disease in chronic traumatic encephalopathyBrainJan29. 19. McKee, A.C., Stern, R.A., Nowinski, C.J., Stein, T.D., Alvarez, V.E., Daneshvar, D.H., Lee, H.S., Wojtowicz, S.M., Hall, G., Baugh, C.M., Riley, D.O., Kubilus, C.A., Cormier, K.A., Jacobs, M.A., Martin, B.R., Abraham, C.R., Ikezu, T., Reichard, R.R., Wolozin, B.L., Budson, A.E., Goldstein, L.E., Kowall, N.W., and Cantu, R.C. (2013). The spectrum of disease in chronic traumatic encephalopathy. Brain Jan 29. doi: 10.1093/brain/aws307.
20.
Amen D.G.Newberg A.Thatcher R.Jin Y.Wu J.Keator D.Willeumier K.2011. Impact of playing American professional football on long-term brain functionJ. Neuropsychiatry Clin. Neurosci.2398-106. 20. Amen, D.G., Newberg, A., Thatcher, R., Jin, Y., Wu, J., Keator, D., and Willeumier, K. (2011). Impact of playing American professional football on long-term brain function. J. Neuropsychiatry Clin. Neurosci. 23, 98–106.
21.
De Beaumont L.Theoret H.Mongeon D.Messier J.Leclerc S.Tremblay S.Ellemberg D.Lassonde M.2009. Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthoodBrain132695-708. 21. De Beaumont, L., Theoret, H., Mongeon, D., Messier, J., Leclerc, S., Tremblay, S., Ellemberg, D., and Lassonde, M. (2009). Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthood. Brain 132, 695–708.
22.
Rabin L.A.Roth R.M.Isquith P.K.Wishart H.A.Nutter-Upham K.E.Pare N.Flashman L.A.Saykin A.J.2006. Self- and informant reports of executive function on the BRIEF-A in MCI and older adults with cognitive complaintsArch. Clin. Neuropsychol.21721-732. 22. Rabin, L.A., Roth, R.M., Isquith, P.K., Wishart, H.A., Nutter-Upham, K.E., Pare, N., Flashman, L.A., and Saykin, A.J. (2006). Self- and informant reports of executive function on the BRIEF-A in MCI and older adults with cognitive complaints. Arch. Clin. Neuropsychol. 21, 721–732.
23.
Roth R.M.Isquith P.K.Gioia G.A.2005BRIEF-A: Behavior Rating Inventory of Executive Function—Adult Version: Professional ManualPsychological Assessment ResourcesLutz, FL. 23. Roth, R.M., Isquith, P.K., and Gioia, G.A. (2005). BRIEF-A: Behavior Rating Inventory of Executive Function—Adult Version: Professional Manual. Psychological Assessment Resources: Lutz, FL.
24.
Weir D.R.Jackson J.S.Sonnega A.2009. National football league player care foundationStudy of retired NFL playersInstitute for Social Research, University of Michigan1-37. 24. Weir, D.R., Jackson, J.S., and Sonnega, A. (2009). National football league player care foundation. Study of retired NFL players. Institute for Social Research, University of Michigan, 1–37.
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Copyright 2013, Mary Ann Liebert, Inc.
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Published in print: July 15, 2013
Published online: 15 July 2013
Published ahead of print: 11 July 2013
Published ahead of production: 19 February 2013
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