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Cognitive and Neuropsychiatric Function in Former American Football Players
Anna Aaronson1, Grace Badlam1, Shania C Mulayi1
1Boston University Alzheimer's Disease Research Center, Boston University CTE Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
JAMA Network Open
|February 27, 2026
Summary
Former American football players show worse cognitive and neuropsychiatric function later in life. This study links football participation to these declines, suggesting a dose-response relationship with years and level of play.
Area of Science:
- Neuroscience
- Sports Medicine
- Public Health
Background:
- Repetitive head impacts (RHI) in American football are linked to cognitive and neuropsychiatric issues later in life.
- Previous studies were limited by small sample sizes, focus on elite athletes, and lack of control groups.
Purpose of the Study:
- To investigate the association between American football participation and cognitive and neuropsychiatric function in men aged 40 and older.
- To assess the impact of RHI proxies, such as years of play and level of competition, on neurological outcomes.
Main Methods:
- A cross-sectional study utilizing online data from the Head Impact & Trauma Surveillance Study (HITSS).
- Compared 3970 former football players with matched controls from the Brain Health Registry.
- Utilized computerized cognitive tests, subjective cognitive concern scales, and depressive symptom inventories, adjusting for age, race, education, and vascular risk.
Main Results:
- Former football players exhibited poorer performance on memory tests (PALFAMS, PALTEA), reported higher cognitive concerns (ECog), and showed more depressive symptoms (GDS-15) compared to controls.
- A dose-response relationship was observed: professional players and longer duration of play were associated with worse outcomes.
- Years of play correlated with increased cognitive concerns, executive function deficits (BRI), and depressive symptoms.
Conclusions:
- American football participation is associated with diminished cognitive and neuropsychiatric function in later life.
- Findings suggest a significant dose-response relationship between the extent of football play (years and level) and adverse neurological outcomes.
- Results provide valuable context for clinicians and researchers in assessing risks for former football players.
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