Drawing on our dedicated team’s experience of operating a midlife brain health clinic for retired elite contact sport athletes, The Advanced BRAIN Health Clinic (ABHC) at our facility, research led by Dr Neil Graham with Jessica Hain, Erin Rooney, Dr Richard Sylvester and Prof. David Sharp, (co-authors and colleagues from the ABHC), outlines a practical framework for assessing individuals with cognitive concerns. This framework emphasises key clinical features, approaches to investigation, including neuroimaging and advanced fluid biomarkers. symptomatic management strategies, and emerging research directions.
There is growing concern among former athletes about the potential link between head injuries and dementia. Neurologists are increasingly evaluating retired contact sport athletes who present with cognitive and behavioural difficulties following repetitive head impacts and traumatic brain injury. These assessments can be complex, given the wide range of possible diagnoses, including psychiatric conditions, trauma-related impairments, and, in some cases, neurodegenerative diseases. A variety of underlying pathologies may be present after repeated trauma, such as Alzheimer’s disease and chronic traumatic encephalopathy (CTE).
Despite the vast expertise of our specialist team of leading brain health experts including neurologists, lecturers and researchers, current understanding of the specific clinical profiles associated with different forms of post-traumatic dementia remains limited, and in vivo diagnostic tests for many of these conditions are still lacking.
Below are some key points from this research:
- Retired players may develop neurological or psychiatric problems that relate to previous injuries, psychological factors or, more rarely (in those <60 years), neurodegeneration.
- Substantial repetitive head impacts exposure and single traumatic brain injury are associated with increased dementia risk, so clinicians should systematically take a head injury history.
- However, many cognitive complaints are explained by treatable non-neurodegenerative issues such as psychological/psychiatric factors, sleep or pain.
- Features suggesting underlying neurodegeneration include caregiver concern, progressive functional decline, abnormal examination, objective cognitive deficits and supportive biomarkers (which remain non-specific for chronic traumatic encephalopathy).
- Ex-player brain health should also be supported by addressing modifiable dementia risk factors such as smoking, alcohol, blood pressure management, obesity, physical activity, hyperglycaemia, hyperlipidaemia, low mood, isolation and sensory impairment.
Dr Neil Graham, lead author, shared:
“We set out a practical approach for clinicians assessing and managing former contact sports players with brain health concerns, including how best to manage uncertainty about conditions like CTE, for which doctors currently lack specific tests. Hence, it will be vital to follow up our cohort over time to clarify what the findings mean for brain health, and how we can best help people at higher risk of long-term problems.”
The UK Advanced Brain Health Clinic (ABHC) study was created to find ways to protect brain health, reduce dementia risk, improve predictions and diagnose brain changes earlier.
Access the framework.
