This study correlates number of concussions with cognitive impairment, depression, anxiety, and player position in retired NFL players.

A retrospective observational study was conducted on 85 retired NFL players evaluated in a brain injury clinic. These players were given the Montreal Cognitive Assessment (MoCA), the Generalized Anxiety Disorder (GAD) test, the Patient Health Questionnaire (PHQ-9). They were then asked to report the number of concussions and significant concussions and other injuries.

61/85 former players (71.8%) reported an abnormal MoCA score (<26). This study confirms an increased number of professional and total football seasons also correlated decreased MoCA score (p=0.044, p=0.033 respectively). 73% of the players showed mild to severe levels of anxiety & depression. Significant concussions, was found to be highly correlated with both PHQ-9 (p = 0.012) and GAD-7 scores (p = 0.024). Group 3 (offensive/defensive lineman, tight ends, and linebackers), had the greatest number of non-significant and significant concussions (40.9 and 5 respectively). Cognitive impairment was more significant in Group 4 as 50% of players had mild or moderate MoCA scores and 40% had a severe score.

We found cognitive impairment in former NFL players with impaired delayed recall and low composite MoCA Scores. We also found there is a linear decline in MoCA scores with longer career lengths. Strong correlation between the number of concussions with loss of consciousness and PHQ-9 and GAD-7 scores. This indicates the number of concussions experienced by a player is indicative of their depression and anxiety levels post-retirement. Low-speed positions in group 3 generally incur frequent low-speed head impacts, which may explain the larger number of significant and non-significant concussions. Conversely, the positions in Group 4 incur less frequent, high-speed head impacts, resulting in more cognitive impairment.