IN FOCUS: Dementia research in football

IN FOCUS: Dementia research in football

​Anecdotal evidence has been building for years to support the theory that professional footballers have been at heightened risk of dementia in later life.

Obituary after obituary featuring players from the 1950s, 60s and 70s have ended with reference to the cruelty of either dementia or Alzheimer’s disease, but more significantly, pathological evidence has emerged which suggested a potential link between heading footballs and developing dementia, most prominently with the case of former England striker Jeff Astle.

This week, the findings of a landmark study conducted in Scotland revealed that former professional footballers had an approximately three and a half times higher rate of death due to neurodegenerative disease than expected. The majority of media reports and headlines then stated that ex-players were three and a half times more likely to die of dementia, but it is important to note that the neurodegenerative diseases studied in the report also included conditions such as motor neurone disease and Parkinson’s disease, in addition to various forms of dementia. In fact, former footballers were found to be five times more likely to die of Alzheimer’s disease, the most common form of dementia, and two times more likely to die of Parkinson’s disease.

The study, led by consultant neuropathologist Dr Willie Stewart, honorary clinical associate Professor at the University of Glasgow, related only to senior level football players. Therefore, conclusions cannot be applied beyond that sphere – not to age level football such as schools or youths, and not even to amateur football - but the findings will be examined by all contact sports, such as rugby.

At this stage it is too early to draw any firm conclusions for other sports, because of the different aspects of contact involved in each discipline, and further research is required to understand what is behind the findings.

For instance, it has long been assumed that increased incidence of dementia in football was caused by heading the ball, but the study does not provide compelling evidence on that front. It is estimated that the average footballer heads the ball between six to 12 times per game. A goalkeeper might head the ball during a game no more than a dozen times in his entire career, yet the study found that mortality with neurodegenerative disease listed as the primary or a contributory cause of death did not differ significantly between goalkeepers and outfield players, although dementia-related medications were found to be prescribed less frequently to goalkeepers.

Of course, heading a ball does not apply to rugby, but it is far more of a contact sport than football, and blows to the head do happen.

Scottish Rugby has developed strict guidelines on concussion to minimise the risk, assist identification, and appropriately manage any instances, under the guidance of its chief medical officer Dr James Robson, to help ensure the game is played as safely as possible. This proactive approach is being extended to dementia.

Commenting on the study’s findings this week, he stated: “Scottish Rugby is aware of this important work. It will take time to digest the findings and what the implications are for other sports.

“We are actively engaged with some of the study’s authors, looking at ways to prevent dementia and its effects in sport.”

What has been largely overlooked this week is that the study also confirmed that sport has very significant health benefits. It was found that former footballers were less likely to die of other common diseases, such as heart disease and some cancers, including lung cancer.

“Whilst every effort must be made to identify the factors contributing to the increased risk of neurodegenerative disease to allow this risk to be reduced,” said report author Dr Stewart, “there are also wider potential health benefits of playing football to be considered.”

It is no secret that exercise is good for us, but the study sample showed that professional footballers lived an average of three and a half years longer than the rest of the population up to the age of 70.

This backs up research elsewhere in sport conducted by Scottish international athlete Dr Andrew Murray in 2016, which found that playing golf can increase life expectancy, prevent diseases and improve mental health, because of the exercise involved. Golf is likely to improve cardiovascular, respiratory and metabolic health, as well as improving balance and muscle endurance.

Further research into the cause of neurodegenerative diseases will now follow, first in football and then almost certainly in other fields. Sports as we know them may have to introduce significant change to respond to new findings. But this should not be feared. New measures leading from greater medical understanding should ultimately help to make competition even safer, and the lifelong benefits of sport even greater.In fo

Donald Walker offers a guest perspective as a former Sports Editor and then Deputy Editor of The Scotsman from 1998 to 2019 and is writing a series on rugby.

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