Sports Medicine

, Volume 47, Issue 6, pp 1209–1220 | Cite as

A Comparison of Cognitive Function in Former Rugby Union Players Compared with Former Non-Contact-Sport Players and the Impact of Concussion History

  • Patria A. Hume
  • Alice Theadom
  • Gwyn N. Lewis
  • Kenneth L. Quarrie
  • Scott R. Brown
  • Rosamund Hill
  • Stephen W. Marshall
Original Research Article
Part of the following topical collections:
  1. Rugby Health

Abstract

Aim

This study investigated differences in cognitive function between former rugby and non-contact-sport players, and assessed the association between concussion history and cognitive function.

Methods

Overall, 366 former players (mean ± standard deviation [SD] age 43.3 ± 8.2 years) were recruited from October 2012 to April 2014. Engagement in sport, general health, sports injuries and concussion history, and demographic information were obtained from an online self-report questionnaire. Cognitive functioning was assessed using the online CNS Vital Signs neuropsychological test battery. Cohen’s d effect size statistics were calculated for comparisons across player groups, concussion groups (one or more self-reported concussions versus no concussions) and between those groups with CNS Vital Signs age-matched norms (US norms). Individual differences within groups were represented as SDs.

Results

The elite-rugby group (n = 103) performed worse on tests of complex attention, processing speed, executive functioning, and cognitive flexibility than the non-contact-sport group (n = 65), and worse than the community-rugby group (n = 193) on complex attention. The community-rugby group performed worse than the non-contact group on executive functioning and cognitive flexibility. Compared with US norms, all three former player groups performed worse on verbal memory and reaction time; rugby groups performed worse on processing speed, cognitive flexibility and executive functioning; and the community-rugby group performed worse on composite memory. The community-rugby group and non-contact-sport group performed slightly better than US norms on complex attention, as did the elite-rugby group for motor speed. All three player groups had greater individual differences than US norms on composite memory, verbal memory and reaction time. The elite-rugby group had greater individual differences on processing speed and complex attention, and the community-rugby group had greater individual differences on psychomotor speed and motor speed. The average number of concussions recalled per player was greater for elite rugby and community rugby than non-contact sport. Former players who recalled one or more concussions (elite rugby, 85 %; community rugby, 77 %; non-contact sport, 23 %) had worse scores on cognitive flexibility, executive functioning, and complex attention than players who did not recall experiencing a concussion.

Conclusions

Past participation in rugby or a history of concussion were associated with small to moderate neurocognitive deficits (as indicated by worse CNS Vital Signs scores) in athletes post retirement from competitive sport.

References

  1. 1.
    McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvořák J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47(5):250–8.CrossRefPubMedGoogle Scholar
  2. 2.
    King D, Gissane C, Brughelli M, Hume PA, Harawira J. Sport-related concussions in New Zealand: a review of 10 years of Accident Compensation Corporation moderate to severe claims and costs. J Sci Med Sport. 2014;17(3):250–5.CrossRefPubMedGoogle Scholar
  3. 3.
    England Professional Rugby Injury Surveillance Project Steering Group. England Professional Rugby Injury Surveillance Project 2013–2014 Season Report. Twickenham. 2014.Google Scholar
  4. 4.
    Theadom A, Starkey NJ, Dowell T, Hume PA, Kahan M, Feigin V. Sports-related brain injury in the general population: an epidemiological study. J Sci Med Sport. 2014;17(6):591–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Quarrie KL, Murphy IR. Towards an operational definition of sports concussion: identifying a limitation in the 2012 Zurich consensus statement and suggesting solutions. Br J Sports Med. 2014;48(22):1589–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Carney N, Ghajar J, Jagoda A, Bedrick S, Davis-O’Reilly C, du Coudray H, et al. Executive summary of concussion guidelines step 1: systematic review of prevalent indicators. Neurosurgery. 2014;75:S1–2.CrossRefPubMedGoogle Scholar
  7. 7.
    Kerr ZY, Register-Mihalik JK, Marshall SW, Evenson KR, Mihalik JP, Guskiewicz KM. Disclosure and non-disclosure of concussion and concussion symptoms in athletes: review and application of the socio-ecological framework. Brain Inj. 2014;28(8):1009–21.CrossRefPubMedGoogle Scholar
  8. 8.
    Gardner A, Iverson GL, Williams WH, Baker S, Stanwell P. A systematic review and meta-analysis of concussion in rugby union. Sports Med. 2014;44(12):1717–31.CrossRefPubMedGoogle Scholar
  9. 9.
    Kirkwood G, Parekh N, Ofori-Asenso R, Pollock AM. Concussion in youth rugby union and rugby league: a systematic review. Br J Sports Med. 2015;49(8):506–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Broglio SP, Eckner JT, Paulson HL, Kutcher JS. Cognitive decline and aging: the role of concussive and subconcussive impacts. Exer Sport Sci Rev. 2012;40(3):138–44.Google Scholar
  11. 11.
    Iverson GL, Brooks BL, Collins MW, Lovell MR. Tracking neuropsychological recovery following concussion in sport. Brain Inj. 2006;20(3):245–52.CrossRefPubMedGoogle Scholar
  12. 12.
    Iverson GL, Gaetzy M, Lovell MR, Collins MW. Cumulative effects of concussion in amateur athletes. Brain Inj. 2004;18(5):433–43.CrossRefPubMedGoogle Scholar
  13. 13.
    Hume PA, Quarrie K, Lewis G, Theadom A. IRB/NZR/AUT RugbyHealth project final report. A technical report to the International Rugby Board and New Zealand Rugby. Auckland: Sport Performance Research Institute New Zealand, Auckland University of Technology, New Zealand. 2015.Google Scholar
  14. 14.
    Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction. 1993;88(6):791–804.CrossRefPubMedGoogle Scholar
  15. 15.
    Gualtieri CT, Johnson LG. Reliability and validity of a computerized neurocognitive test battery CNS Vital Signs. Arch Clin Neuropsych. 2006;21(7):623–43.CrossRefGoogle Scholar
  16. 16.
    Boyd A. CNS Vital Signs manual. 2015. http://www.cnsvitalsigns.com/WhitePapers/CNSVS-BriefInterpretationGuide.pdf. Accessed Feb 2015
  17. 17.
    Gualtieri CT, Johnson LG. Neurocognitive testing supports a broader concept of mild cognitive impairment. Am J Alzheimers Dis Other Demen. 2005;20(6):359–66.CrossRefPubMedGoogle Scholar
  18. 18.
    Hopkins WG. A scale of magnitudes for effect statistics. In: Hopkins WG (ed). A new view of statistics. 2002. http://www.sportsci.org/resource/stats/effectmag.html. Accessed 26 Jan 2009.
  19. 19.
    Alberts JL, Linder SM. The utilization of biomechanics to understand and manage the acute and long-term effects of concussion. Kinesiol Rev. 2015;4(1):39–51.CrossRefGoogle Scholar
  20. 20.
    DeKosky S, Ikonomovic M, Gandy S. Traumatic brain injury: football, warfare, and long-term effects. N Engl J Med. 2010;363:1293–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Hollis SJ, Stevenson MR, McIntosh AS, Shores EA, Collins MW, Taylor CB. Incidence, risk, and protective factors of mild traumatic brain injury in a cohort of Australian non professional male rugby players. Am J Sport Med. 2009;37(12):2328–33.CrossRefGoogle Scholar
  22. 22.
    Shuttleworth-Edwards AB, Smith I, Radloff SE. Neurocognitive vulnerability amongst university rugby players versus noncontact sport controls. J Clin Exp Neuropsychol. 2008;30(8):870–84.CrossRefPubMedGoogle Scholar
  23. 23.
    West S. Substance abuse among persons with traumatic brain injury: a review. Neurorehab Neural Repair. 2011;25(1):3–8.CrossRefGoogle Scholar
  24. 24.
    Holsinger T, Steffens D, Phillips C, Helms M, Havlik R, Breitner J. Head injury in early adulthood and the lifetime risk of depression. Arch Gen Psychiatry. 2002;59(1):17–22.CrossRefPubMedGoogle Scholar
  25. 25.
    Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Harding HP, Matthews A, et al. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sport Exer. 2007;39(6):903–9.CrossRefGoogle Scholar
  26. 26.
    Lehman E, Hein M, Baron S, Gersic C. Neurodegenerative causes of death among retired National Football League players. Neurology. 2012;79(19):1970–4.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Casson IR, Siegel O, Sham R, Campbell EA, Tarlau M, DiDomenico A. Brain damage in modern boxers. JAMA. 1984;251(20):2663–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Gronwall D, Wrightson P. Delayed recovery of intellectual function after minor head injury. Lancet. 1974;304(7881):605–9.CrossRefGoogle Scholar
  29. 29.
    Rabadi M, Jordan B. The cumulative effect of repetitive concussion in sports. Clin J Sports Med. 2001;11(3):194–8.CrossRefGoogle Scholar
  30. 30.
    Austin D, Gabbett T, Jenkins D. Tackling in professional rugby league. J Strength Cond Res. 2011;25(6):1659–63.CrossRefPubMedGoogle Scholar
  31. 31.
    Dretsch MN, Silverberg ND, Iverson GL. Multiple past concussions are associated with ongoing post-concussive symptoms but not cognitive impairment in active-duty army soldiers. J Neurotrauma. 2015;32(17):1301–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Arciniegas DB, Anderson CA, Topkoff J, McAllister TW. Mild traumatic brain injury: a neuropsychiatric approach to diagnosis, evaluation, and treatment. Neuropsychiatr Dis Treat. 2005;1:311–27.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Fleminger S, Ponsford J. Long term outcome after traumatic brain injury. Br Med J. 2005;331:1419–20.CrossRefGoogle Scholar
  34. 34.
    Decq P, Gault N, Blandeau M, Kerdraon T, Berkal M, ElHelou A, et al. Long-term consequences of recurrent sports concussion. Acta Neurochir (Wien). 2016;158(2):289–300.CrossRefGoogle Scholar
  35. 35.
    De Beaumont L, Brisson B, Lassonde M, Jolicoeur P. Long-term electrophysiological changes in athletes with a history of multiple concussions. Brain Inj. 2007;21:631–44.CrossRefPubMedGoogle Scholar
  36. 36.
    De Beaumont L, Lassonde M, Leclerc S, Théoret H. Long-term and cumulative effects of sports concussion on motor cortex inhibition. Neurosurgery. 2007;61(2):329–36.CrossRefPubMedGoogle Scholar
  37. 37.
    De Beaumont L, Theoret H, Mongeon D, Messier J, Leclerc S, Tremblay S, et al. Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthood. Brain. 2009;132(Pt 3):695–708.CrossRefPubMedGoogle Scholar
  38. 38.
    Dean PJA, Steer A. Long-term effects of mild traumatic brain injury on cognitive performance. Front Hum Neurosci. 2013;7:30.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    McCrory P, Meeuwisse WH, Kutcher JS, Jordan BD, Gardner A. What is the evidence for chronic concussion-related changes in retired athletes: behavioural, pathological and clinical outcomes? Br J Sports Med. 2013;47:327–30.CrossRefPubMedGoogle Scholar
  40. 40.
    Alexander DG, Shuttleworth-Edwards AB, Kidd M, Malcolm CM. Mild traumatic brain injuries in early adolescent rugby players: long-term neurocognitive and academic outcomes. Brain Inj. 2015;29(9):1113–25.CrossRefPubMedGoogle Scholar
  41. 41.
    Shuttleworth-Edwards AB, Radloff SE. Compromised visuomotor processing speed in players of Rugby Union from school through to the national adult level. Arch Clin Neuropsychol. 2008;23(5):511–20.CrossRefGoogle Scholar
  42. 42.
    Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Cantu RC, Randolph C, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005;57(4):719–26.CrossRefPubMedGoogle Scholar
  43. 43.
    Statistics New Zealand. Statistics New Zealand census data. Wellington. Statistics New Zealand. 2006. http://www.stats.govt.nz/Census/about-2006-census/information-by-variable/cigarette-smoking-behaviour.aspx. Accessed 15 Dec 2014.
  44. 44.
    Kerr ZY, Mihalik JP, Guskiewicz KM, Rosamond WD, Evenson KR, Marshall SW. Agreement between athlete-recalled and clinically documented concussion histories in former collegiate athletes. Am J Sport Med. 2015;43(3):606–13.CrossRefGoogle Scholar
  45. 45.
    Kerr Z, Marshall S, Guskiewicz K. Reliability of concussion history in former professional football players. Med Sci Sport Exerc. 2012;44(3):377–82.CrossRefGoogle Scholar
  46. 46.
    Kerr Z, Marshall S, Harding HJ, Guskiewicz K. Nine-year risk of depression diagnosis increases with increasing self-reported concussions in retired professional football players. Am J Sport Med. 2012;40(10):2206–12.CrossRefGoogle Scholar
  47. 47.
    Arnaiz E, Almkvist O, Ivnik RJ, Tangalos EG, Wahlund LO, Winblad B, et al. Mild cognitive impairment: a cross-national comparison. J Neurol Neurosurg Psychiatry. 2004;75(9):1275–80.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Bruscoli M, Lovestone S. Is MCI really just early dementia? A systematic review of conversion studies. Int Psychogeriatr. 2004;16(2):129–40.CrossRefPubMedGoogle Scholar
  49. 49.
    Quarrie KM, Gianotti S, Hopkins WG, Hume PA. Effect of nationwide injury prevention programme on serious spinal injuries in New Zealand rugby union. Br Med J. 2007;334:1150–3.CrossRefGoogle Scholar
  50. 50.
    King DA, Hume PA, Brughelli M, Gissane C. Instrumented mouthguard acceleration analyses for head impacts in amateur rugby union players over a season of matches. Am J Sports Med. 2015;43(3):614–24.CrossRefPubMedGoogle Scholar
  51. 51.
    King DA, Hume PA, Gissane C, Clark T. Similar head impact acceleration measured using instrumented ear patches in a junior rugby union team during matches in comparison with other sports. J Neurosurg Pediatr. 2016;18(1):65–72.CrossRefPubMedGoogle Scholar
  52. 52.
    King D, Brughelli M, Hume PA, Gissane C. Concussions in amateur rugby union identified with the use of a rapid visual screening tool. J Neurol Sci. 2013;326(1–2):59–63.CrossRefPubMedGoogle Scholar
  53. 53.
    King D, Gissane C, Hume PA, Flaws M. The King-Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand. J Neurol Sci. 2015;351(1–2):58–64.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Patria A. Hume
    • 1
  • Alice Theadom
    • 2
  • Gwyn N. Lewis
    • 3
  • Kenneth L. Quarrie
    • 4
  • Scott R. Brown
    • 1
  • Rosamund Hill
    • 5
  • Stephen W. Marshall
    • 6
  1. 1.Faculty of Health and Environmental Sciences, Sports Performance Research Institute New ZealandAuckland University of TechnologyAucklandNew Zealand
  2. 2.National Institute for Stroke and Applied NeurosciencesAuckland University of TechnologyAucklandNew Zealand
  3. 3.Health and Rehabilitation Research InstituteAuckland University of TechnologyAucklandNew Zealand
  4. 4.New Zealand RugbyWellingtonNew Zealand
  5. 5.Department of NeurologyAuckland City HospitalAucklandNew Zealand
  6. 6.University of North Carolina Injury Prevention Research CentreChapel HillUSA

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