May 4, 2000 (San Diego) -- Old football players don't die, their brain function just fades away. New research presented here at the 52nd annual meeting of the American Academy of Neurology raises questions about the risks young people take when they engage in aggressive contact sports.
Barry D. Jordan, MD, MPH, and Julian Bailes, MD, surveyed men who had played high school, college, or professional football, asking them about their football history, current medical symptoms, past medical history, family medical history, and social history. The players' average age at the time of the survey was 53, and they had spent an average of 17 years playing football.
Of the nearly 1,100 men who responded, 60% reported at least one concussion, and 26% reported three or more during their combined amateur and professional careers. Of the 40 men who had played quarterback, a whopping 80% sustained at least one concussion.
"A statistically significant association was noted between a self-reported history of concussion and complaint of memory changes, confusion, speech difficulties, problems remembering short lists, and difficulty recalling recent events," Jordan and Bailes write. Those with a history of concussion also had a higher frequency of headache, movement disorders, and hearing or balance problems, they say.
Concussion is the mildest but most common form of traumatic brain injury, says Jordan, who directs the traumatic brain injury program at the Burke Rehabilitation Hospital in Mamaroneck, N.Y. Symptoms include confusion, disorientation, and forgetfulness. For example, he says, a football player may forget the previous play or return to the wrong sideline.
Contrary to popular belief, loss of consciousness is not a symptom of a mild concussion. However, Jordan warns, some athletes and coaches may think that if the player hasn't blacked out, he is all right and can return to the game.
"Any concussion is something to be concerned about," Jordan says. "The problems occur if someone returns [to the field] while still feeling the effects of the first concussion and suffers a second concussion ... or [they occur] from the cumulative effects of multiple concussions."
Treatment consists of waiting for the symptoms to resolve and reassuring the patient he will be all right. Persistent symptoms deserve further evaluation. "If I see a boxer who's complaining of headaches 2 days later, that's when I start to worry," Jordan says.
Several recent studies have shown that high school, college, or other amateur athletes with a history of at least one concussion performed significantly worse on tests of learning and memory than their teammates who had not suffered head injuries. The greater the number of concussions sustained, the worse the athletes' scores, leading an author of one of those papers to conclude that a young person who suffers multiple concussions could have problems with memory, concentration, and decision-making severe enough to impair school performance.
The risk of permanent brain damage is extremely low in children who sustain just one concussion during the junior high or high school years, says Ricardo Senno, MD, attending physician in the traumatic brain injury program at the Rehabilitation Institute of Chicago.
"The brain repairs itself from one concussion," he tells WebMD. "The issue is multiple concussions, and the severity of the injury. If you get concussion after concussion after concussion, you could have mild ... impairment," consisting of deficits in memory and concentration later in life.
"If a child is prone to multiple concussions, he or she probably shouldn't play that sport," Senno tells WebMD when asked to comment on the study. He recommends parents, coaches, and physicians think about taking a child out of a particular activity if he or she sustains two or more concussions in a season. Unfortunately, says Jordan, no data exist to help determine when someone might be too young to start playing football.
The best way to prevent permanent brain or nerve injury is to "minimize the risk of multiple injuries to the head," says Senno. "Wear the appropriate helmet, not just during competitive sports but recreational sports as well, such as skiing or bike riding." Seatbelts and, for younger children, car restraints are also important safety measures, he says.
Jordan recommends that people in high-risk sports simply participate less. People who get concussions should wait until their symptoms subside and be evaluated by a coach, nurse, or team physician before getting back in the game. James Kelly, MD, of the Rehabilitation Institute of Chicago has developed a sideline evaluation guide that coaches can use to determine if a player can return to the field, says Senno.
"It is crucial to prevent 'second-impact syndrome,'" he says. He describes this as receiving two concussions back to back. Signs that someone needs a more extensive examination include persistent headaches, disorientation, memory lapses, episodes of nausea or vomiting, vision problems, muscle weakness, or numbness or tingling anywhere on the body.