Can heading a football cause dementia and, if so, how high is the risk? John Windell discusses recent research with Dr Gemma Lace-Costigan.
West Bromwich Albion fans called Jeff Astle (pictured) “The King”. He wore the number 9 shirt at the club from 1964 to 1974, played 361 times and scored 174 goals. He got the winner in the 1968 FA Cup Final and was the top scorer in Division 1 in 1969-70. Astle had a reputation for being a great header of the ball. They said he scored more with his head than with his feet.
He retired in 1977, but in 1997 his health began to fail sharply. A scan revealed that the front part of his brain had shrunk and softened. In January 2002 he collapsed and died. The coroner at the inquest ruled the cause was “death by industrial disease”. He had suffered brain damage from repeatedly heading heavy leather footballs, which had triggered chronic traumatic encephalopathy (CTE), a form of dementia.
Since then, his family has campaigned for more research into the link between dementia and heading the ball.
They enjoyed a major victory in February when Acta Neuopathologica published research from a team at University College London and Cardiff University who had examined the brains of six former football players diagnosed with dementia. Five had been professionals, the other a long-term amateur. The post-mortem examinations found that, while all six had Alzheimer’s disease, four also had signs of CTE.
For the Jeff Astle Foundation, it was the sort of PR that money can’t buy. But just as the study was being discussed on the main TV bulletins, the researchers themselves were reminding people of the limitations of the work.
The Biomedical Scientist asked Dr Gemma Lace-Costigan, a lecturer in molecular bioscience at the University of Salford who specialises in Alzheimer’s research, what she thought this study did, or didn’t achieve, from a scientific point of view.
What was your reaction to the research? Did it surprise you in any way?
“The study describes evidence of CTE in the brains of four retired footballers who had developed dementia. CTE has previously been linked to other sports that involve repeated head trauma, such as boxing and American football, and so one might predict that any activity associated with recurrent head injuries might also result in similar brain changes.”
Could blows to the head from a football trigger dementia, or are they more likely a small part of bigger picture?
“While it’s known that significant head injuries can result in impaired brain function, it’s unclear how repeated, lower impact head trauma over a period of years may influence neural function. A combination of genetic and environmental factors are likely to underlie the development of dementia. This study did not consider the role of inherited or lifestyle factors, which may have also had a significant role to play. So it remains unclear.”
Do the limitations of the research undermine the validity of the findings? Or does the study remain an important addition to the body of evidence?
“This was only a small study, but it backs up other research in the field that has also found a link between CTE and repeated head trauma. It really highlights the need for further research to understand the molecular mechanisms underlying the association between repeated low-impact head injuries and dementia.”
Should authorities look into banning children from heading the ball, as is the case in the USA?
“A wealth of research describes the physical, psychological and social benefits of exercise for children, so the findings here should be interpreted with caution. It looked at a few individuals who played a lot of football over many years, so any associations cannot be extrapolated to the general population, especially children.”
In the 60s, footballs were heavy. Could modern footballs be less of a danger?
“The study did not look at the exact nature of the association between repeated low impact head blows and dementia. This needs investigating. A number of elements could be explored, including ball weight, age a person begins football training, number and severity of head traumas, other training-related injuries and lifestyle factors. We need to understand which specific factors associated with playing sport are most likely to influence dementia risk and we need to consider these risks in the light of the multiple health benefits associated with remaining physically active.”
Dr Gemma Lace-Costigan is a Molecular Bioscience Lecturer at University of Salford
Dementia and football
2002
Jeff Astle dies as a result of brain damage.
The PFA and FA begin a joint study into the issue.
2012
A study from the US Centers for Disease Control and Prevention finds retired American football players are three times more likely to die from neurodegenerative diseases than the general population.
2014
NFL data reveals that 6,000 of 20,000 retired American football players will suffer from Alzheimer’s disease or moderate dementia some day.
2015
NFL sets up $1bn fund to compensate former players with head injuries.
US Soccer recommends that children under the age of 10 should not head the ball during games.
The Jeff Astle Foundation launches in the UK to raise awareness and promote research.
2016
The Daily Telegraph launches “Tackle footballs’ dementia scandal”. It writes: “Experts have told us that the incidence rate among the 1966 heroes is ‘frightening’ but they had already become alarmed by the anecdotal evidence of the devastating stories.”
2017
UEFA and the FA both announce they will fund major independent research into the link between dementia and playing football.
