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Behind the headlines: Football and dementia

Dr Carol Routledge

Scientists have today announced results from the Football’s InfluencE on Lifelong Health and Dementia Risk (FIELD) study. This is the largest study to date looking back at the long-term health of professional football players, including their risk of dementia.

The results will naturally raise questions from anyone interested in the sport, so here’s everything you need to know about the findings.

Headlines from the FIELD study

The FIELD study, commissioned by The Football Association (FA) and Professional Footballers’ Association (PFA), looked at electronic health records for 7,676 male, ex-professional football players in Scotland. Over the course of the study, 1,180 of the players passed away, the majority of whom would’ve been at the height of their careers between the 1950s and 1980s.

An independent research team from the University of Glasgow led by Prof Willie Stewart compared their death records and prescription information with 23,028 people from the general population who had the same age, sex and socio-demographic profile.

They found:

  • Players lived just over three years longer than non-players.
  • They were less likely to die of heart disease and lung cancer.
  • They were 3.5 times more likely to die of dementia.

The study was limited by the accuracy of the medical records the researchers could access, especially for the older players in the study and we know that historically dementia hasn’t been consistently reported in these records. But, it’s only due to the quality and availability of health records in Scotland that a study of this size and type has even been possible in the UK.

What’s behind the dementia link?

The shortest answer is: we don’t know. The study did not look at what aspects of the players’ lifestyle or experience on or off the pitch made them more likely to die of dementia.

Clearly playing professional football brought a range of health benefits, so the strong association with dementia needs to be taken on board by football association across the world. It now forms a solid basis for high-quality research to understand why.

Putting the results in context

Dementia is caused by a range of different brain diseases, the most common being Alzheimer’s. In the majority of cases, the risk factors for these diseases are very complex.

For diseases like Alzheimer’s, genetics is thought to contribute to around two-thirds of our individual risk, and our health and behaviours influence the other third.

The most consistent evidence to date suggests that heart health is one of the biggest influencers of brain health for the majority of the population. So common risk factors like high blood pressure, smoking, physical inactivity and diabetes could have a big impact on dementia rates at a population level.

Heavy smoking can double a person’s risk of developing dementia, so the 3.5-fold increased risk of dying from dementia for former professional footballers in this study must be taken seriously.

But while around 7.4m people in the UK smoke and 16m have high blood pressure, there are far fewer professional footballers – around 4,000 in the UK. There are no studies to date that suggest the same dementia risks would extend to the millions of grassroots football players in the UK and across the world.

Head injury and heading the ball

In recent years, boxing and American football have been at the centre of a growing number of studies linking head injury and dementia risk. Alzheimer’s Research UK researcher Dr Neil Graham discussed this on our blog last year.

More advanced research into these sports has implicated repeated head injuries as a likely factor, causing a particular type of dementia called CTE (chronic traumatic encephalopathy).

CTE has many similar symptoms to other forms of dementia, like Alzheimer’s disease, but the changes in the brain are distinctively different under a microscope and more characteristic of physical trauma. Today, CTE can only be diagnosed post-mortem, after someone has died.

There have been very few studies looking at potential long-term effects of head injury in football, or the impact of heading in the sport.

The FIELD study was designed to explore whether there was a higher risk of dementia in professional players and not what could be behind it. The study did not look at head injury experienced by these players, or any other factor on or off the pitch that could’ve contributed to their risk.

Answering these questions will be an important focus now for future research, and the football and research communities must be open to exploring all possibilities.

Is football safe?

People will naturally think about themselves, their children and their footballing heroes as a result of this news, but this study into former professional players doesn’t tell us whether the modern professional or grassroots game needs to change or how.

Sport brings a range of health benefits and this paper shows that’s true for former professional footballers too. But the more that research like this can tell us about the potential risks of sport, the better governing bodies can help manage those risks.

Today’s professional football game is very different to that played by the majority of the players in the FIELD study, with safety now a major priority across a range of sports. As a result of the findings, The FA has re-issued their guidelines on concussion management and good training practice across all levels of the game.

Dementia is caused by complex brain diseases and our risk is influenced by our genes, lifestyle and health. The best evidence suggests that good heart health is the best way to keep the brain healthy, so when played safely, a kick around with friends is still a great way to stay mentally and physically active.

What next for research into football and dementia?

The FIELD study results raise further important questions about professional football and dementia, and today’s findings must galvanise global efforts to fund more research to address them.

We hope to see more data from the FIELD study in the coming months and years and the FA’s independently chaired Medical & Football Advisory Group has recommended that a specialist Research Taskforce be convened to review current evidence. Alzheimer’s Research UK is part of that Taskforce, acting as an independent advisor to The FA to help prioritise the direction of future research.

Only last week, the Drake Foundation announced a 10-year study of more than 200 professional footballers across a range of countries to look at long-term health of 27-year-old players pre- and post-retirement.

We’ll keep you updated on funding and results as they are announced.

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