Brain disease risk more than doubled in rugby players


Wednesday, 05 October, 2022


The risk of neurodegenerative disease among former Scottish international rugby union players is more than double that of the general population, according to new research published in the Journal of Neurology Neurosurgery & Psychiatry, prompting a call for strategies to cut the risks of head impact and traumatic brain injury across all sports, including in training.

Post-mortem studies of brain tissue have previously uncovered evidence of neurological disease uniquely associated with a previous history of traumatic brain injury or repetitive head impact exposure in former professional gridiron, soccer and rugby union players. In this study, Scottish researchers wanted to find out if the risk of neurodegenerative disease might also be higher among former rugby players than it is among the general population.

The study included 412 Scottish former international male rugby players (out of an initial total of 654) who were aged at least 30 by the end of 2020. The players were matched for age, sex and socioeconomic status with 1236 members of the public. National electronic health record data on hospital admissions, prescription meds and the most common causes of death among Scottish men were used to track the health and survival of both groups for an average of 32 years from the age of 30 onwards.

During the monitoring period, 121 (29%) of the former rugby players and 381 (31%) of the comparison group died. Former rugby players were older when they died, reaching an average age of nearly 79 compared with just over 76 in the comparison group. Former rugby players also had lower rates of death from any cause until they reached the age of 70, after which there was no difference between the two groups.

But the chance of being diagnosed with a neurodegenerative disease was more than twice as high among the former rugby players (11.5%) than it was among the comparison group (5.5%), although risks varied by condition. The risk of a dementia diagnosis was just over twice as high, while that of Parkinson’s disease was three times as high, and that of motor neurone disease/amyotrophic lateral sclerosis 15 times as high. The field position (forward or back) of the former rugby players had no bearing on neurodegenerative disease risk.

The researchers acknowledged that 37% of former international rugby players who might have been eligible for inclusion in the study had to be excluded in the absence of matched health records; that the study focused only on men; and that information was not available on total career length in rugby, history of head impact and traumatic brain injury, or other potential risk factors for dementia. But the study was relatively large and long term, and the findings echo those of previous studies of former professional soccer and gridiron players.

“Notably, in contrast to data from the NFL [National Football League] and soccer, our cohort of rugby players largely comprises amateur athletes, although participating at an elite, international level. In this respect, it is the first demonstration that high neurodegenerative disease risk is not a phenomenon exclusive to professional athletes,” the researchers said.

The researchers noted that rugby authorities have taken steps to improve the detection of concussion injuries and to reduce the risks during match play. However, they said head impact exposures and concussion risk are not isolated to match play, so measures to reduce exposures in training might also be considered a priority.

“In addition to these primary prevention measures, interventions targeted towards risk mitigation among former rugby players with already accumulated head impact exposures might also be considered, including the development of specialist brain health clinics,” they added.