Early Tackle Football Exposure Linked to Later-Life Clinical Impairment

 I played a tiny bit prior to high school, as a freshman practiced a couple weeks and decided it was not for me.

Early Tackle Football Exposure Linked to Later-Life Clinical Impairment

 Younger age at first exposure to tackle football was not associated with CTE presence or severity but was linked to worse informant-reported cognitive, neurobehavioral, and neuropsychiatric outcomes among deceased players aged 60 years and older. Earlier tackle football exposure was linked to worse later-life clinical outcomes but not chronic traumatic encephalopathy (CTE) pathology, according to results published in the Journal of Neurotrauma Risk for CTE is increased with repetitive head impacts sustained during contact sports. However, prior studies have indicated that several neurodegenerative and cerebrovascular pathologies can result from repetitive head impacts. Some of this heterogeneity may be due to the age at first exposure to contact sports. Researchers from Boston University Chobanian & Avedisian School of Medicine and Harvard Medical School analyzed data from 677 deceased male former American football players from the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Brain Bank. The donors were evaluated for CTE pathology, cognitive function, and behavior on the basis of age at first exposure to tackle football. Prospective, population-based studies of former American football players are necessary to better understand the relationship between younger [age at first exposure] to tackle football and clinical impairments. Participants were stratified by age at death: 277 died before age 60, and 400 died at age 60 and older. Those who died before age 60 years had a mean (SD) age at death of 39.9 (12.4) years compared with 74.6 (8.2) years among those who died at or after age 60 (P<.001). The younger group had a younger mean (SD) age at first exposure (10.1 [3.00] vs 11.9 [2.7] years;P<.001), fewer mean (SD) years of play (11.1 [5.7] vs 13.0 [5.7] years; P<.001), and were less likely to have played football professionally (26.1% vs 45.8%; P<.001). The proportion of White participants was 74.6% in the younger group and 87.3% in the older group (P=.002). Overall, 471 donors (69.6%) had CTE. Evidence of CTE was observed among 57.0% of the younger and 78.3% of the older participants (P<.001). The severity of CTE increased with age (P < .001). Among those younger than 60 years, CTE stages were I (36.7%), II (31.0%), III (29.7%), and IV (2.5%) compared with 4.5%, 8.3%, 43.6%, and 43.6%, respectively, among those 60 years and older. The younger cohort also had lower rates of Alzheimer disease (1.8% vs 30.3%; P<.001) and Lewy body disease (P<.001) with brainstem (1.1% vs 10.8%) or limbic or neocortical (1.8% vs 12.3%) predominance compared with the older cohort, respectively. In the younger cohort, age at first exposure did not predict any cognitive, neurobehavioral, or neuropsychiatric outcomes (all P ³.292). In the older cohort, however, age at first exposure was associated with the composite cognitive (standardized b, -0.133;P=.009), neurobehavioral (standardized b, -0.119; P=.035), and neuropsychiatric (standardized b, -0.113; P=.048) scores. Each year older at first exposure was associated with lower odds of impairment on the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A) Metacognition Index (OR, 0.774; P =.028), Cognitive Difficulties Scale (OR, 0.775; P =.003), and Behavioral Regulation Index (OR, 0.831; P =.044).

No association was observed between age at first exposure and CTE presence or stage.

Study limitations include the retrospective reporting of clinical outcomes.

The study authors concluded, “Prospective, population-based studies of former American football players are necessary to better understand the relationship between younger [age at first exposure] to tackle football and clinical impairments.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Nosek SB, Gil SG, Abdolmohammadi B, et al. Younger age of first exposure to American football is associated with worse informant-reported clinical outcomes in older age brain donors. J Neurotrauma. Published online February 13, 2026. doi:10.1177/08977151261424707