Does playing football cause dementia?

As the Professional Footballers’ Association teams up with experts to produce a guide to help former players and their families, NHS England’s National Clinical Director for Dementia examines the links between the beautiful game and the devastating illness:

There has been much interest recently about the association between the development of dementia and playing football.

This is described in the context of the repeated action of heading the ball. What is the evidence for this and what can or should we do?

Dementia is an umbrella term with many different causes – Alzheimer’s disease is probably the most recognisable and best known. In practice, particularly in older people, there can be evidence of several different types in the same person – the shrinkage of particular regions of the brain as seen in Alzheimer’s disease, vascular changes similar to those which cause strokes or the effects of trauma.

It has been known for some time that major head injury is a significant risk factor for developing dementia later in life.  A significant blow to the head associated with loss of consciousness does seem to cause changes in the brain and predisposes to the later development of dementia, separate to any acute effects on memory, orientation and behaviour directly as a result of a blow to the head.

It is well recognised that boxers can develop dementia – sometimes called dementia pugilistica or, colloquially, ‘boxer’s brain’ – often characterised by slowing of movement and thought processes. The most famous example being Mohammed Ali. Of course, in boxing, trying to knock someone out could be regarded as the raison d’etre of the sport. In football, repeated minor knocks to the head, without loss of consciousness, such as is seen with heading the ball is a side effect.

The National Football League in America has banned heading of the ball and the protective gear that American footballers wear, including crash helmets, emphasises the concern which led to that ban. Similar effects might be seen in rugby although often the effects of spinal injury when a scrum collapses are more prominent in the public’s mind.

Anecdotally, many clinicians recognise seeing patients who are ex-professional footballers.  Jeff Astle, the ex-West Bromwich Albion and England footballer, developed dementia in his mid-forties and died at the age of 59 in 2002. The landmark report from the coroner, based on medical evidence, designated the death as a work related one, caused by repeated heading of the ball.  The condition is referred to by the not very catchy title, CTE – Chronic Traumatic Encephalopathy.

The documentary on the BBC from Alan Shearer, Dementia, Football and Me, shown on 1st November 2017, painted a wide ranging and helpful picture of the issue through the eyes of the iconic football star. Jeff Astle’s daughter, Dawn noted the hiatus in interest between 2002 and now and there were poignant interviews by Alan Shearer with the family of players like Matt Tees and 1966 World Cup winner Nobby Stiles, were prominent.

Descriptions  from distinguished neuroscientists, psychologists and pathologists saw Alan Shearer go through a number of tests about his own cognition and brain function and it was shown very clearly that the old leather balls, when wet, weighed about half as much again as when they were dry. Alan Shearer noted that for every goal he scored, he must have had a thousand equivalent headers on the practice ground.

There could well be a link between repeated knocks to the head, perhaps resulting in a feeling of being dazed, and the development of dementia.  However, the crucial evidence that proves a firm association between the two is currently lacking.  Interestingly, as described by Alan Shearer, the practice of football is changing and the image that many of us have from our youth of a goalie kicking a ball well over the half way line to be headed by a centre forward is a much less common sight now.

An important message from the Alan Shearer film was about the public perception of dementia and the effects on families. There is still a reluctance for diagnosis and an interview with an ex-professional footballer, who had difficulty with memory, suggested he did not want any investigations and an ex professional footballer’s grandchildren were reluctant to curtail their own footballing activities.

Alan Shearer had a great session with Sporting Memories, who have teamed up with the PFA to produce a guide aimed at helping former players and their families. Sporting Memories is a fantastic group who, not specific to dementia, bring people together and engage with reminiscence. An important message was one about prevention – generally the fit lifestyle that footballers live should have a protective effect.

So, everyone should continue enjoying a weekend 5- a- side as the positive effects that camaraderie and physical activity brings clearly outweigh any potential ill effects. More definitive studies should inform the public health messages around sport, not exclusive to dementia, but including it.

The description of the ‘beautiful game’ and the stress on carers with dementia was one of the main take-home messages from Alan Shearer’s excellent documentary.

Football captures the public imagination like nothing else and has the ability to convey powerful messages – when Wayne Rooney hurt his foot in 2006, the nation quickly became expert on the metatarsal bone.  Perhaps, in time, the same could be true for dementia.

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Professor Alistair Burns

Professor Alistair Burns is Professor of Old Age Psychiatry and Vice Dean for the Faculty of Medical and Human Sciences at The University of Manchester.

He is an Honorary Consultant Old Age Psychiatrist in the Manchester Mental Health and Social Care Trust (MMHSCT) and is the NHS England’s National Clinical Director for Dementia and Older Peoples’ Mental Health.

He graduated in medicine from Glasgow University in 1980 and trained in psychiatry at the Maudsley Hospital and Institute of Psychiatry in London. He became the Foundation Chair of Old Age Psychiatry in The University of Manchester in 1992, where he has been Head of the Division of Psychiatry and a Vice Dean in the Faculty of Medical and Human Sciences, with responsibility for liaison within the NHS. He set up the Memory Clinic in MMHSCT and helped establish the old age liaison psychiatry service in UHSMT. He is a Past President of the International Psychogeriatric Association.

He is Editor of the International Journal of Geriatric Psychiatry and is on the Editorial Boards of the British Journal of Psychiatry and International Psychogeriatrics. His research and clinical interests are in mental health problems of older people, particularly dementia and Alzheimer’s disease. He has published over 300 papers and 25 books.

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