Brain Health in Former Professional Motorsport Drivers: Case Series in a Population Exposed to Sport-Related...

Professional motorsport drivers face a high risk of concussions and repeated subconcussive head impacts due to their exposure to significant g-forces. Concussion symptoms may persist in some individuals, and repeated head impacts are thought to contribute to a gradual accumulation of axonal damage over time. However, little is known about the long-term neurological consequences of practicing professional motorsports. This case series aimed to present the neurological health status of former professional motorsports drivers and to explore potential relationships between cumulative head impacts exposure, resulting from professional motorsport practice over time, and long-term brain health.

Recruitment began following a concussion awareness campaign led by the Automobile Club de Monaco targeting former professional motorsport drivers. Neurological health status was examined through clinical assessments (SCAT5 symptom inventory, neuropsychological assessment, video-oculography) and through neuroimaging (MRI with SWIp sequences and diffusion tensor imaging (DTI); 18 FDG-PET). We correlated data with cumulative head impact exposure, encompassing total motorsport exposure duration, professional practice duration, and self-reported concussion numbers.

12 former professional motorsport drivers (all male, age 55.8 ± 12.1) were recruited, including 58% with cognitive complaints and 50% with motorsport-related concerns. They had a mean motorsport practice duration of 31.3 ± 5.8 years, with a mean professional career of 26.3 ± 6.5 years, and a mean retirement age of 40.4 ± 5.6 years. While all participants had engaged in multiple motorsport disciplines, 83% had competed in Open-wheel single-seater racing and/or Sport car racing. 75% had at least one symptom on SCAT5 (2.5 ± 2.8), 33% at least one cognitive impairment (0.4 ± 0.7), 75% at least one impaired eye movement (1.5 ± 1.1), 58% at least one MRI abnormality (0.9 ± 1), 92% at least one DTI abnormality (1.8 ± 1.4) and 33% at least one 18 FDG-PET abnormality (0.7 ± 1.2). Attention (25%), processing speed (58%), visual episodic (58%), and working (50%) memory skills were above average. Only eye movement abnormalities were correlated to total exposure duration and to professional practice duration.

This case series revealed that former professional motorsport drivers presenting with brain health concerns frequently exhibited mild, nonspecific neurological abnormalities. Two findings were particularly noteworthy: first, eye movement abnormalities correlated with cumulative motorsport exposure duration, and second, participants showed an atypical cognitive profile with above-average visuospatial and processing speed performances. This unique profile may make standard clinical assessments less sensitive for detecting subtle pathological processes-whether during their active career or later in life. While no causal links can be established, the observed findings may stem from cumulative head impact exposure and a high cognitive reserve, both of which might be inherent to professional motorsport practice. These observations highlight the need for large-scale longitudinal studies that integrate pre-season baselines with video-oculography and DTI, along with prolonged post-career follow-up, to specifically investigate the effects of repeated head impacts on this population during their career and throughout aging.